Permit II il CITY OF TIGARD PLUMBING PERMIT
tt ••• . COMMUNITY DEVELOPMENT Permit #: PLM2013 -00168
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 06/05!2013
Parcel: 2S 101 AA06400
Jurisdiction: Tigard
Site address: 12323 SW 66TH AVE
Project: Selectron Subdivision: WEST PORTLAND HEIGHTS Lot: 32
Project Description: Add (1) lay, (1) shower stall & (1) toilet, cap (1) sink and relocate (1) sink & (2) urinals
Contractor: CENTRAL PLUMBING Owner: STONER, DAVID S
5915 SE STEELE ST. 338 SE SPOKANE ST
PORTLAND, OR 97206 PORTLAND, OR 97202
PHONE. 503 - 597 -3303
HONE. 503 - 771 -5820
FAX.
FEES
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 06/05/2013 $25.02
Specifics: 1 ea Sink 06/05/2013 $25 02
1 ea Laundry Tray 06/05/2013 $25 02
Type of Use: COM 1 ea Tub /Shower /Shower Pan 06/05/2013 $12.51
Class of Work: ALT 2 ea Urinal 06/05/2013 $50 04
Type of Const: 1 ea Water Closet 06/05/2013 $25.02
Occupancy Grp: 1 12% State Surcharge - 06/05/2013 $19.52
Stories: Plumbing
Total $182.15
-- 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 nrk 's suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Noti tion Cente . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -0 - 90. You may obtain a copy of the rules
or direct uestions to OUNC , • a • g 503.232.1987 or 1 800.332.2344.
Issued y: OJ / I , . j Permittee Signature: t ! r ,/ ~
/ ,
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 Application
Building Fixtures FECEIVED Rece tOR OFFICE USE ONLY Ci}ty �, of Ti ang d (0 �/ i'-'!�//�- t�6 /�CJ
Date/By
l PertmtNo
a 13125 SW Hall Blvd., Tigard,OR 97223JUN - 5 2013 ( Date/By. (`�'
Plan Review �•
Other Permit No Vw �y O1 //7
0 Phone: 503.718.2439 Fax: 503.598 1960
1.1 G `� D Inspection Line 503.639 4175 CITY OF TIGAR Date ReadyBy Suns El See Page 2 for
Internet. www.tigard -or.gov LDItVQ DIVISION FEE* Supplemental Information 5
TYPE OF W FEE• SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total W
X Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) 1
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2- family dwelling Om
`Comercial/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: I a3a3 SI W 6 ( Catch basin or area drain 18 76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: -V-1(� Ki z �l
Footing drain (no. linear ft.: ) Page 2
g•
Suite/bld / t. no.: �\// I Project . � j ec name: sO ee�'U� � ty AS Manufactured home utilities 50.03
Cross street/directions,to job site: g J - 6&^I Manholes 18.76
J
L e i t Rain drain connector 18.76 _ '
f 1 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.: a6 /0/ „c-l9. O 10406 Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve v 12.51
�p1
'° ,,,,pp � � ! / Clothes washer 25.02
fa IL in ed 4 gJD eq. - kr. 9 40 ; Ket a r)% �� f Dishwasher 25.02
Aria l LAU add 1 54 el JeT ( h `' �p�-Y 6 1 D fountain 25.02
a d I. .+.01ltt fi,4.I Jc. Ejectors /sump 25.02
g PROPERTY OWNER I ❑ TENANT ert^i4 Expansion tank 12.51
Name: 040 i a s S +VN € Odd Fixture /sewer cap / 25.02 A5:03-
Address: Pd b B. -7 Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City /State /ZIP: Pb rt OIL aj 7 - 2 Pa. Hose bib 25 02
Phone: (S03 )a3s Fax: ( ) Ice maker 12.51
❑ APPLICANT ' CONTACT PERSON Interceptor /grease trap 25 02
Business name: 13 {V' f 3 0-tier Ccr•S'i IA-. t 0 h ,1 Medical gas (value: $ ) Page 2
��22 Primer 12.51
Contact name:
Ve k QUfi %er- Roof drain (commercial) 12.51
Address: I i 1 0 2 # iv (? /'S?S-I 1 t (' r..,2.eCA•I.e. Sink/basin/lavatory o t:• , 25.02 1.
City /State /ZIP: t . t (\3_ bfog- , 1 2.7../ Solar units (potable water) 62.54
Phone: ( Su3) 965 - a gf2 I Fax: : ( ) Tub /shower /shower pan f • 12.51 42.5
E -mail: bey j cJ61„ (p ry,L+�q$t X t Urinal ' 25.02 � plf
CONTRACTOR Water closet J 25.02 0 1 . 67).2
Water heater 37.52
Business name: t' +'i 7 4 9/ di+,.bt ► I Water piping/DWV 56.29
Address: /C se 6 wele 5t I Other: 25 02
City /State /ZIP: RC\+ . 9 j g4-2i 6 Subtotal /&„2 43
Phone: (98) - 7..-( - cot() Fax: ( ) Minimum permit fee: $72.50 --°
CCB Lic.: --7.-
8 VA, Plumbing Lic. no.: C$ I Plan review
(25% of permit fe
//y � I State surcharge (12% of permit fee) /.,5?'
Authorized signature: I TOTAL PERMIT FEE Q�. /
Print name: 1, �So 1" D V t Ief Date: �„ >Sl /3 This permit application expires if a permit is not obtained within 180 day)
'C c/ after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:\ Budding \Permus\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 - 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
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 ❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath: =Tub /Shower
engineer.
- Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Dave Thru 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
❑ 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/Rrfrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station) R2 l o CA4t
Rec. Vehicle Dump Station
Shower: -Gang RI 1 0 t i.14-+e Z
-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 l plumbing permit can be issued.
Urinal
Other Fixtures:
I:\ Building \Permits\PLMF_PermitApp.doc 08/04/2011 2
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
12323 SW 66TH AVE, TIGARD, OR, 97223
Commercial - Plumbing
320 Plumbing rough-in
06/06/2013 00:00
PLM2013-00168
PART
NOTE Breakroom sink and shower u/s only rough/test with water pass
Violation Summary:
Inspector Contractor