Permit CITY OF TIGARD PLUMBING PERMIT
3 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00078
T I G AR Ei 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/13/2013
Parcel: 1 S133DC16100
Jurisdiction: Tigard
Site address: 13018 SW LAURMONT DR
Project: Banks Subdivision: VILLAGE AT SUMMER LAKE PARK Lot: 16
Project Description: Replacing 50' water service
Contractor: ANYTIME PLUMBING & DRAIN CLEANING Owner: BANKS, LEROY Y & CYNDY F
3333 NW 35TH AVE, BLDG C 13018 SW LAURMONT DR
PORTLAND, OR 97210 TIGARD, OR 97223
PHONE: 503 - 432 -8275 PHONE:
FAX: 971 - 255 -1965
FEES
Quantity Description Date Amount
50 If Water Service 03/13/2013 $62.54
Specifics: 10 ea Minimum Fee Adjustment - 03/13/2013 $9.96
Plumbing
Type of Use: SF 1 12% State Surcharge - 03/13/2013 $8.70
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
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 rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ' r [� , , p 414.0± Permittee Signature: , A PPb 0-7 De I
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar. 13. 2013 9:37AM No. 7733 P. 1
Piumoing rermit Application RECEIVE
Building Fixtures Q FOR OFFICE USE ONJ.Y'
City of Tigard MAR 1 e7 2013 Received • PetmitN
+ 13125 SW Hell Blvd., Tigard, OR 97223 �+�/ Date/By: 3// 3 i 3 o -: PCII r 3 -oat. •
: p Phone: 503.639.417I Fax: 503.598.19 (CI 1 J< OF TTG Plan Review ew Other Permit No.:
Inspection Line, 503 ale/By:
L'1t�n BUILDING I ateReadyBy.' rud 3eePa¢e2for
Internet: www.tigard-or.gov Notified/Method: a. Supplemeuralruformation
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El New construction ❑ Demolition T For special irtfornrafion use checklist
P Description I Oty. I Ea. Total
M Addition/alteration/re Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R. for each utility connection)
! - '`-alj:. :: .,., '. 1;.::CAT t/ t'. QF' ' YCI ' {� � ;... , , : SPR (I) bath 312.70
ill 1- and 2- family dwelling In Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi-family
Each additional bath/kitchen 25.02
❑ Master builder Q Other: Fire sprinkler (_ sq. ft.) Page 2 • 'V a,L ,`''''' :; 4 :'Ya'$)T ' NBOR141 LOCATIO' '; ' " f t��'' . ..: i' Site utilities:
_lob site address: I 1 D 1 �l 7 01 % (, r A, ` p IrUI Y A ii y br. Catch basin or area drain 11.76
/ /� �J Drywell, leach line, or trench drain 18.76
City/State/ZIP: .. 1 A t ,V G, , ' 1 1 v Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt_no.: Project name: I ,� 1 y J(�h/anKs Manufactured home utilities 50.03
Cross street/directions to job site: Y Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ,__4 Page 2
Water service (no. linear ft „'r(/) I Page 2
Subdivision: Lot no.: Fixture or item: -
Tax map /parcel no.: Backflow preventer 31.27
. . • Backwater valve 12.51
' DESCRIPTION.OF WORK' • • Clothes washer 25.02
I d ' 1 1) 1 1 4C r ./r Dishwasher 25.02
Drinking fountain 25,02
Ejectors/sump 25.02
. Ni 'PROPERTY OWNER . . ❑ TENANT Expansion tank 12.51 •
Name: , 11 ( i) Q-ta� � - Fixture/sewer cap 25.02
I [� Floor drain/floor sink/hub 25.02
AddrtsS: Garbage disposal 25.02
City /State/ZTP: /� V/ r + ' #1174t Hose bib 25.02
Phone: ( ) v � Fax: ( ) Ice maker 12.51
:.�s :'.'ta :I ('� APPLICANT ..
Interceptor/grease trap I � x : 1 5 :1 �I ` CONTACT' PERSON Ptor /grease tra 25.02
Business name; ANyf1 M l; ?U M PANq t bRA (WAN /N17 Medical gas (value: $) Page 2
Primer 12,51
Contact name: ASf}t Di _ M I (.�. Roof drain (commercial) 12,51
Address: ,2', NW 6 114 kVV bW 1 List Ill ✓r7 G Sink/basin/lavatory 25.02
City/State/ZIP: PORTLAND, DP- 0112/0 Solar units (potable water) 62.54
Phone: (5U ) 4•b2- %2-1 f5 Fax: : (11)) Z.. ) Gi 1 Tub /shower /shower pan 12,51
P
E -mail: (N �p kN�1 Y rn>; ps m . ki S
Urinal 25.02
�r + + . ,U_ . _ Water closet 25.02
COIITRACTO�It.' :�
• Water heater 3732
Business name; AIN i i tri G PIilAI'Yl fiiW t • A241N (t&W I NL1 Water piping/DWV 56.29 r
Address: ' NW t� 5"171 ( � j o l c, Other; 25.02
City /State/ZIP: PJ2121LU'N rd , OK 41210 Subtotal ( i , S'f
( 411) Minimum permit fee: $72.50 �?„ sO .
Phone: ( SO ) 47_- 32-16 Fax: (411) �j�J' - I � rA S
Plan review (25% of permit fee)
CCB Lic.: 1 ei 1 2_,GLG1 - I f c r I if Plumbing Lic, no.: 1 gi + State surcharge (12% of pcnnit fcc) g, 10
Authorized signature: A TOTAL PERMIT FEB $ f, Lo
Print name: AS f(r/ m LL �- ' Date: 2 f 1 I I , i ^ This permit application expires it a permit is not obtained within 180 days
[(try after it has been accepted as complete.
'Fee methodology set by Tri•County Building Industry Service Board.
I :1Buildln2tPermiMPt .Mil- PermiApp.doe 10/01/09 440
Mar, 13. 2013 9:37AM No. 7733 P. 2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential•Fire Suppression Systems:
+''" :'i�+'nY• ti . • �i;w:i1(:00^. .:' �2;J':: o-`4wJ:.�� "ii ^i ,t.TE^�tr' >s. : Slid:s -';.-a n <J
yy ((.. tip �y�' Qa +'• 0 'X'` C e /:; .x,„9t81'. /jr alp �.�(../,r1 i t� wi: iiii tl iFas sn k,r.' �,,.
•. .Ab,�'.rA:krC� lYJ3iV .L•.::'tiJ:::i, „�G 't:u.l'1 : a . � v.'��F,.cv�• .....,,S:Cf�,�,� � :., ,....uFuN'.M tf�..,;-„,•‘,.... ':r e.> . , +ee�,: - ..: .,. "�'. , ..:
Footing drain - 1" 100' 50.03 0 to 2,000 5121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer -1st 100' 3,601 to 7,200 $233.20
62.54 7,201 and greater $327,54
Sewer • each additional 100' 37.52
Water Service - 1st 100' I ' 62.54 (02 ,,
Medical Gas Systems:
Water Service -each additional 100'
37.52 viiif rtl � v y: a;; l > :r p�'.:: .. !�
Storm & Rain Drain - 1st 100' ' 62.54 . ini mx. ' e p :. � • ;,..;.:.�
$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 fhst $5,000.00 and $1.52 for
. ili " r ' 'Yiiisiget it '/ /. -. ;r '''' ;•• .1400.7. ' .,'Tat $' each additional $100.00 or fraction thereof, to
• " °` and including $10,000.00.
Inspection of existing plumbing or for $10.001.00 to 525,000.00 $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
Rcinspcction 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: Y/L.S
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", :-: " y . ,
please indicate work performed by fixture. Failure to - ` ` " "' � Yns #allation8.•
Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
Quantity by (Flxture)'Work Performed ❑ Any new commercial building with water service 2" and
'Fixture Type: . ' . Replace greater, except systems designed and stamped by licensed
Prev/o111 CappNl Added . iiistina engineer.
Baptistry/Font
Bath Tub /Shower 1:1 New exterior plumbing site utilities for any complex structure
Tub/Sh/Wltirlpool as defined in 0AR918- 780 -0040.
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive Thru -- ID Any multipurpose fire sprinkler system.
Cuspidor/VVatcrAspirator ❑ Any complex structure as defined in OAR918 780 - 0040.
Dishwasher -Commercial
Domestic Submit 2 sets of plans with any of the above,
Drinking Fountain -
Eye Wash - _- . ; . .,
Eye W Drain/sink 2" ..,.::,."xt.XS jiie triic or•Riser Diagram • . . .. • • .
- ❑ Isometric or riser diagram is required for new buildings
q » that meet the qualifications above.
Car Wash Drain '
v Garbage - Domestic _
Disposal - Commercial
_Industrial . Comments regarding fixture work:
_ Ice Mach.Refrig, Drains
Oil Separator (Gas Station) •
Rec. 'Vehicle Dump Station •
Shower -Gang - ---
-Stall _ -
Sink - Bar/Lavatory
-Bradley
- Commercial *Note: If the fixture work under this permit results in an
-Service increase of sewer EDYJ's, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothcs p
Water Extractor _ plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures: -
http l /www.dgard- or.gov/ city_ hall/departments /cd/docs/PLMF- PermitApedoe