Permit i .
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CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00148
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I CAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/15/2013
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Parcel: 1 S134AA01600
Jurisdiction: Tigard
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Site address: 11341 SW IRONWOOD LP
• Project: Canepa Subdivision: ENGLEWOOD Lot: 69
Project Description: (1) shower valve replacement
Contractor: CHRISMAN PLUMBING INC Owner: CANEPA, FRANK A AND
PO BOX 1706 DEBORAH K
CLACKAMAS, OR 97015 22815 SW HOSLER WAY
SHERWOOD, OR 97140
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PHONE: 503 - 740 -6171
PHONE: 503 - 659 -3307
FAX: 888 - 629 -7654
FEES
Quantity Description Date Amount
13 Plumbing Permit 05/15/2013 $12.51
Specifics: 60 Minimum Fee Adjustment - 05/15/2013 $59.99
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Plumbing •
Type of Use: SF g 12% State Surcharge - 05/15/2013 $8.70
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
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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.
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Issued By: I ,' /J(J „
- (((,,,/ f ,4.0- Permittee Signature: Q � I n A.,Q c.] C ,^ -0O-00,(1_ Yi
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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.
Plumbing Permit Applicati e+ L
Building Fixtures L ED FOR OFFICE USE ONLY �/
C ity of Ti Mg 13 2013 Date /B 5 1513 Permit No.QLp( JO( ( �Q/�d
't 13 SW Hall B lvd., Tigard, OR 972_
1,111 ' • Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Other Permit No.:
Inspection Line: 503.639.4175 CITY OF11GARD Date /By:
T I GAR D *I Date Ready/By: I 6 See Page 2 for
Internet: www.tigard- or.gov BUILDINGDNISIO Notified/Method: I t Supplemental Informa
TYPE -OF -WORK FEE" SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. 1 Total
® Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
' CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building Multi-family
SFR (3) bath 500.32
❑ Mailti -famil
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: 11341 sw Ironwood Catch basin or area drain 18.76
City /State /ZIP: Tigard OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross streeUdirections 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.: 1 S134AA01600 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replace one pressure balance shower valve
Dishwasher 25.02
Drinking fountain 25.02
" "Please email permit to nalda@nwpermlt.com Ejectors /sump 25.02
❑ PROPERTY -OWNER d . ❑ TENANT Expansion tank 12.51
Name: Frank Canepa Fixture /sewer cap 25.02
Floor drain /floor sink /hub 25.02
Address: 11341 sw Ironwood
Garbage disposal 25.02
City /State /ZIP: Tigard OR 97223 Hose bib 25.02
Phone: (503)740 -6171 Fax: ( ) Ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor /grease trap 25.02
Business name: Northwest Permit Inc. Medical gas (value: $ _) Page 2
Primer 12.51
Contact name: Nalda Khan
Roof drain (commercial) 12.51
Address: 1345 Gulf Rd Sink/basin /lavatory 25.02
City /State /ZIP: Point Roberts WA 98281 Solar units (potable water) 62.54
Phone: (360) 945 -2787 Fax: : (360) 945 -2091 Tub /shower /shower pan 1 12.51 12.51
E -mail: naidaCnwpermit.comq Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Cllrisman Plumbing Water piping/DWV 56.29
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Address: PO Box 1706 Other: 25.02
City /State /ZIP: Clackams OR 97015 Subtotal 12.51
Phone: (503) 659 -3307 Fax: (888) 629 -7654 Minimum permit fee: $72.50 72.50
CCB Lic.: 156864 01 (a,.l i3 Plumbing Lic. no.: PB566 Plan review (25% of permit fee)
- { f l State surcharge (12% of permit fee) �, 7D
Authorized signature: 1 �j0 1 j t
TOTAL PERMIT FEE 4 26
Print name: Nalda Khan Date: 5/10/2013 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.
I \Bnddmg \Perm ita\PLMU -P ermitA pp doc 10/01/09 440- 4616T(10 /02/COM /WEB)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr_: Fee (ea) Total _Square Footage: - Permit Fee:,
Footing drain - 1 ° ' 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
Fee (ea) Total each additional $1 00.00 or fraction thereof. to
Other hispections or F e e s , Qty. 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 $1 00.00 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 $1 00.00 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 *.
Quantity by Fixture Type Plan Review for-Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ 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 Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor /Water Aspirator 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.
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Car Wash Drain Isometric or Riser Diagram
Garbage Domestic CI Isometric or riser diagram is required for new buildings
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach. /Re frig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station REPLACE ONE PRESSURE BALANCE SHOWER VALV
Shower -Gang
-Stall
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Sink/Lay - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes p
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:
O:\ FaxMail \Conversion_In\AA005070.doc 2
TO: PERMIT DEPARTMENT
F A )(
FAX NUMBER: (503) 598-1960
FROM: NAIDA KHAN
FAX NUMBER: (360) 945-2091
DATE: 5/10/2013 6:58 AM
REGARDING: PLUMBING APPLICATION ATTACHED
PHONE NUMBER FOR FOLLOW-UP: (360) 945-2787
COMMENTS:
GOOD MORNING,
PLEASE PROCESS ATTACHED PLUMBING APPLICATION.
PLEASE CALL 360-945-2787 FOR PAYMENT OF PERMIT FEES.
PLEASE EMAIL PERMIT TO NAIDA@NWPERMIT.COM
THANK YOU!
NORTHWEST PERMIT INC
1345 GULF RD
POINT ROBERTS, WA 98281
(360) 945-2787 I (360) 945-2091 I WWW.NWPERMIT.COM
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
11341 SW IRONWOOD LP, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
05/16/2013 00:00
PLM2013-00148
PASS - No C of O
Violation Summary:
Inspector Contractor