Permit .. n CITY OF TIGARD PLUMBING PERMIT
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Ir COMMUNITY DEVELOPMENT Permit #: PLM2013 00015
Date Issued: 01/10/2013
T IGARDI 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S102BC01800
Jurisdiction: Tigard
Site address: 10330 SW WALNUT ST
Project: Swinford Subdivision: NORTH TIGARDVILLE ADDITION Lot: 27
Project Description: Bathroom remodel, replace existing fixtures. (1) lay, (1) water closet & (1) tub /shower
Contractor: EXPRESS PLUMBING Owner: SWINFORD, CLARK H &
1420 SE EASTWOOD AMANDA K
PORTLAND, OR 97222 10330 SW WALNUT ST
TIGARD, OR 97223
PHONE: 503 - 380 -6323 PHONE:
FAX
FEES
Quantity Description Date Amount
1 ea Lavatories 01/10/2013 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 01/10/2013 $12.51
1 ea Water Closet 01/10/2013 $25.02
Type of Use: SF 1 12% State Surcharge - 01/10/2013 $8 70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 01/10/2013 $9.95
Occupancy Grp: Plumbing
Stories:
Total $81 20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION' Oregon law requires you to follow the r - . - dopted by the Ore! •,
Utility : - a ion - - -r Thos= rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090 You - ay o•O a copy of t - ,
or di •-ct questions to OU . by • -fling 503.232 1987 or 1.800 332 2344
lss ed By: / Permittee Signature: joy
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Call 503.639.4175 by 7:00 a.m. for the next available inspec f n d •
This permit card shall be kept in a conspicuous place on the job site until omp • •�+ a projec
Approved plans are required on the job site at the time of e. in r/
Plumbing Permit Applic »» _I CEIVED
Building Fixtures ,r
City of Tigard JAN 10 2013 Received /O /5
Permit No • ted �
II U 13125 SW Hall Blvd., Tigard, OR 97223 y
� ff TIGA Plan Review
Phone: 503.718.2439 Fax: 5 Date/By. Other Permit No.:
Inspection Line: 503.639 417 5 RUILDING DIVISION Date Read /B J uris El See Page 2 for
I'IGARD U Ready /By i;
Internet: www.tigard or.gov Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
2 .101?- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 (, 3 D 5 60 ( A 5 Catch basin or area drain 18.76
C � 3 /� Drywell, leach line, or trench drain 18.76
City /State /ZIP:
t V p� �', 1 Footing drain (no linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name S LA_) AY'ef Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.. ) Page 2
Water service (no. linear ft.. ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
(3:4L ` / / f Clothes washer 25.02
/ �^ ( vim. � 5 6 cf? f l # 10-, / e I Dishwasher 25.02
Loc Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain/floor sii*/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value. $ ) Page 2
� � � �' 1 Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory r 25.02 95 6,7,
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan / 12.51 1 g
E -mail: Urinal l 25.02
CONTRACTOR Water closet / 25.02 pZ 6,2,,
/ / _ Water heater 37.52
Business name: C.x ( V , 1,1T -%t Water piping/DWV 56.29
Address: / ti O E,h / ?.c)CJZ'rr,V a_ Other 25.02 6.2i
City/State /ZIP: 0 / 7� ' 0;65 Subtotal �-� r,
Pho (0 3) (y � Ol 75 � � Fax: ( ) S
Minimum permit fee: $72.50 ZR J �
CCB Lic.: 7 V P P. bi no a r'A Plan review (25% of permit fee)
Aga' State surcharge (12% of permit fee) g. 70
Authorized signature: ����� � / // TOTAL PERMIT FEE 7/. A )
Print name: 1D Date: VH0 3 t �� / This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Permits\PLMU- PermitApp doe 10/01/09 440 -4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169 69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62 54
$1.00 to $5,000.00 Minimum fee $72 50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P and including $10,000.00.
Inspection of existing plumbing or for $10,001 00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge — 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90 00/hr $25,001.00 to $50,000.00 $379 50 for the first $25,000 00 and $1.45 for
hours (minimum charge — 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742 00 for the first $50,000.00 and $1.20 for
(minimum charge 1/2 hour) each additional $100.00 or fraction thereof
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash. Each Stall ❑ New exterior plumbing site utilities for any complex structure
Dave Stall as defined in OAR918- 780 -0040.
Cuspidor /Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink - 2"
3" Isometric or Riser Diagram
4 " ❑ Isometric or riser diagram is required for new buildings
- Car Wash Drain
Garbage Domestic non - food that meet the qualifications above.
Disposal - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach /Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink: - Lav/Bar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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