Permit CITY OF TIGARD PLUMBING PERMIT
g : COMMUNITY DEVELOPMENT Permit #: PLM2013 -00133
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2013
Parcel: 2S104CD05900
Jurisdiction: Tigard
Site address: 13685 SW WHITE CEDAR PL
Project: Wisener Subdivision: HILLSHIRE ESTATES Lot: 59
Project Description: (1) sink outdoor
Contractor: POWER PLUMBING CO Owner: NEPOKROEFF, NICHOLAS W &
PO BOX 19418 WISENER, PENNY L
PORTLAND, OR 97280 13685 SW WHITE CEDAR CT
TIGARD, OR 97223
PHONE: 503 - 524 -4953
HONE: 503 - 244 -1900
FAX: 503 - 244 -8825
FEES
Quantity Description Date Amount
1 ea Sink 04/25/2013 $25.02
Specifics: 1 12% State Surcharge - 04/25/2013 $8.70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment - 04/25/2013 $47.48
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: '�tl J Permittee Signature: Y inspection i4•PPt ( 4 -q U J
Call 503.639.4175 by 7:00 a.m. for the next available ins ection 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.
APR /24/2013/WED 02:56 PM POWER PLUMBING FAX No. 503 244 8825 P. 001
Plumbine Permit Application A r1 lic 1)
Building Fixtures ill:�L,/ t. FOR OFFICE USE ONLY
Received
City of Tigard c
ty g APR 2 4 2013 0 Date/13y; � (�-� (3 �" Permit N'' o( 1(d 90 i 3 -- �,>' i3 M 13 125 SW Hall Blvd„ Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 504.598,1960.- D /B Other P e r m i t No..
TIGARD Inspection Line: 503. 639.4175 i I O TIGARD Date Ready By; ]u Sec Page 2 for
Internet: www.tigard- or.gov ^ 1; ,, tst." "-- • • i : r's r ^. Notified/Method: I ( ki supptement.tfaformat
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CI brew construction _ For special information ase checklist >
❑ D emolition
Description I Qty. 1 I Total
adtuon/alteration/replacement ❑ Other: New 1 - 2 di, airings (includes 100 ft. for each utility connection)
ri „w F � �.
r i.,, w '-t M . r ' Pli off t rif.T.;N�':iltt' ° ','A.. ' ' SFR (1) bath 312.70
►1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
Q Accessory building ❑ Multi- family
SFR (3) bath 500.32
--- Each additional bath/kitchen 25.02 -
Li Master builder 0 Other.
Fire sprinkler ( sq. ft) Page 2
! ^ ` ii 5 4 ` ; ;i 1 X 74^ O ,'' t` ,ua a ( D Site utilities:
Job site address: 13 ( 95 Stk) j ,t CL Catch basin or area d 18.76
City /State /ZIP: j't >/ 4/ 01,1 d� D leach line, or trench drain 18,76 -
drain (no. linear ft.: _) Page 2
Suite /bldg, /apt. no.: I Project name: ' J' IV . ' F000titing ng Manufactured home utilities 50.03
Cross street/directions to job site: ""� Manholes 1836
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
a „a "x _tip + i s° .:* Backwater valve 12.51
r te t -` . a - °i liwatavi 1 o 103 - >,' eci rA
I Cloches washer 25.02
M1 f' -5) 1 Tv 2 U\./ -- Dishwasher 25.02 _
Drinking fountain 25.02
Ejectors/sump 25,02
z' 7447 `1 f$41"° a, *- 3 .. •ram".• -,sdc ' - A �r:, ?" . Expansion tank 12.51
,
tCly tom �, . ,
P (1 ^ , � e 1 � Fixture/sewer cap 25,02
Name t/V V r1 ��r
Floor drain /floor sink/hub 25,02
Address:
Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
f :•' i�
•• a ^!;'
- � � • �'@ ` � fi`r ; � � � ('�$ '��"'" Interceptor /grease nap 25.02
'' ,x .ham . rfi✓CMw �, • . : nr.
Business name: ° Z/ A.)--t - I a t h/1 Medical gas (value: $ _) Page 2
Primer 1251
Contact name. /,(.,nt/- ti -t. Roof drain (comrneicial) 12.51
Address: C./ ij 'k' ie gi � Sink/basin/lavatory / 25.02 '�`ji}�
City / State/ZIP: Oft) t) V y vl i -).4 0 Solar units (potable water) 62.54
Phone: ( ) tl-___ /G) v U I Fax: : ( ) , 2„;/.:q _ ?:•MS Tub /shower /shower pan - 12.51
E-mail: Urinal 25.02
..y ra3 a - `4.1",' T -��Q •, , . r .'.,�,- �, . �• " "ic1 �. ' -,, C f, . Water closet 25.02
, h .•f.�. ; 21" .. ...� t ;Wi:� . ;;t , 44.- i i � :alit I:.YY ; [ ., ,s , , `te ygw .iii4. ,.T Water heater
37,52
Business name: Pu �� ° .. A.:-/ r Water in 29
r pp P�D WV 56
Address: ' Q � -- Other: 25.02
City /State/ZIP: 1 Subtotal
Phone: ( ) ,a r 9 W Fax: ( ) � y` 9- q Z� Minimum permit fee: $72,50 -72,P
CCl3 Lie.: -- 7C( � Plumbing Lie. no.: 3 1 Plan review (25% of permit fee)
J ' � State surcharge (12% of permit foe) y 7
Authorized signature; TOTAL PERMIT FEE. k - ( ` 2 U
y � _ T - - - 4" � 4 . T h f s permit application expires ire permit is not obtained within 18I dfday, name: PIYnname: - /� J Leif' Date: alter It has been accepted a$ wmplete.
'Fee methodology set by Tn -County Building Industry Service Board.
i'' auilding\Permils'PLMU•Pe:miulpp da,; 10/01/09 440.4t 16T(10/02/COM/WfB)
APR /24/2013/WED 02:56 PM POWER PLUMBING FAX No.503 244 8825 P.002
E umbini Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su r ression S stems: i
,. �� y.�$ � ?Y S' o z s+ i ' 1. -f:, F"�,
Err
le_l- f R �? T h , ;, T 1 t f rt y Jtk ,.
Footing drain -1° 100' 50.03 MINI 0 to 2,000 $121.90
Footing drain - each additional 100' 37.32 2,001 to 3.600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st I00' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st WO' MUM Medical Gas S stems:
Water Service - each additional 100' _ 37.52 .iFivn� w,: Ixn�y
Storm & Rain Drain - 1st 100 62.54 r �
_ $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
[ ? , * , ,,: a F r? ;_i each additional $100.00 or fraction thereof to
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 ch:: -1/2 hour and including $25,000.00.
Inspections outside of nonnal business IIII 90.00A4 - $25,001.00 to $50,000.00 $379,50 for the first $25,000.00 and $1.45 for
hours minimum char: e -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 char : e - 1/2 hour each additional $100.00 or fraction thereof,
Subtotal:
Commercital Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurate! re ort fixtures could result in increased sewer fees *.
?, . n^ �� axe W �. 3' ^' ,,, e � F yr ��c xa """' 7 t 5
, t 1 � *: 0ggi, t��{ a3..utr�ii 1 1nik c4 1.t rt r f a. 7 , I L [ ! [ t t ' t � 1�
�4. G N
11 ""V��P IJ,I��r�Lr - P�r .�°' ..t.. ac L L � y � . i c �r` Plan review is required for any of the following.
� r � ? � y `x 4 '� ..,.,._. .�i
'i• W t - • f'
Baptistry/Font PIease check all that apply.
Bath - Tub /Shower CI Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thm El New exterior plumbing site utilities for any complex structure
Cuspidor/WaterAspitator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918 780 - 0040.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
-3 "
EM 9� 'tt 3`J'.� J�! +_�:� r�•.:7]
Car wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic -non -food a� s re tl
Disposal - Domestic -food related that meet the • : Iifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refri:. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rea. Vehicle Dump Station
Shower -Gang
- Stoll ~
Sink/I.av -Non-food related
- Bradley -
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: •
http: / /www.tigard- or.gov /city hall/ departments /cd/ dots /PLIIIF- PermitApedoc
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13685 SW WHITE CEDAR PL, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
05/10/2013 00:00
PLM2013-00133
PART
NOTE. Addition front and about 1/2 of left side EZ Flow foundation drain with back water
valve ok for cover. EZFlow installation instructions provided by contractor.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13685 SW WHITE CEDAR PL, TIGARD, OR,
97223
Residential - Plumbing
320 Plumbing rough-in
05/01/2013 00:00
PLM2013-00133
PASS
NOTE: DWV rough/test with water pass.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13685 SW WHITE CEDAR PL, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
05/16/2013 00:00
PLM2013-00133
PASS - No C of O
Violation Summary:
Inspector Contractor