Permit CITY OF TIGARD PLUMBING PERMIT
Is • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00259
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/30/2013
Parcel: 2S 111 DD00201
Jurisdiction: Tigard
Site address: 15943 SW HALL BLVD
Project: Cozy Nails & Spa Subdivision: SUMMERFIELD NO.7 Lot: N
Project Description: Install (2) bacfkflow devices, (1) clothes washer, (5) 2" floor drains, (2) sinks, (1) water heater and (10) pedicure
chairs.
Contractor: LOTUS PLUMBING COMPANY Owner: ROSEHILL INVESTMENTS LLC
8100 SW ELMWOOD ST 2001 SIXTH AVE STE 2300
PORTLAND, OR 97223 SEATTLE, WA 98121
PHONE: 503 - 522 -2728 PHONE:
FAX: 503 - 892 -2639
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 07/29/2013 $62.54
Specifics: 1 ea Clothes Washer 07/29/2013 $25.02
5 ea Floor Drain /Floor Sink/Hub 07/29/2013 $125.10
Type of Use: COM 2 ea Sink 07/29/2013 $50.04
Class of Work: ALT 1 ea Water Heater 07/29/2013 $37.52
Type of Const: 250 Misc Other Fee 07/29/2013 $250.20
Occupancy Grp: 1 12% State Surcharge - 07/29/2013 $66.05
Stories: Plumbing
Total $616.47
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 OOUN calling 503.232.1987 or 1.800.332.2344.
l
Issued By: // ivt, Permittee Signature:
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 dF
FOR OFFICE USE ONLY City of Tigard R E I/ yQ'�® DDate/By: 7 o O� Permit No.: P�jyaa/3 - ooh
n 13125 SW Hall Blvd., Tigard, OR 97 3 AllirMili
Plan Review
II Phone: 501718.2439 - Fax: 503.59 ' 60� - D ateBy: Other Permit No.: , ) t ' d 3 / -
T I G n It D Inspection Line: 503.639.4175 . L 9 2013 Date Ready/By: runs: ®See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
• TYPE •
'OF 3 . '. iii) _ FEE* SCHEDULE '
❑ New construction I3U �Detr DIVISION For special information use checklist
Description I Qty. I Ea. I Total
( Addition/alteration/replacement El Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
� CATEGORY OF CONSTRUCTION ' • SFR (1) bath 312.70
El 1- and 2- family dwelling Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory l
ry g ❑Multi - family lt�
Each additional bath/kitchen 25.02
❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE - INFORMATION .AND LOCATION Site utilities: < V • ` I '
3 1/ Catch basin or area drain 18.76
Job site address:
a#4( # g+.0 lief / !3 /v
Drywell, leach line, or trench drain 18.76
City /State /ZIP: 'rig et i-el (K C 7,2a L
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
SW �✓ 4„ ‘ Pi Rain drain connector 18.76
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.: Backflow preventer Z, 31.27 4 LY '1
DESCRIPTION- OF WORK • Backwater valve 12.51
/ /_ n Clothes washer / 25.02 0 1
S it {.rc.e�j vt[9[✓lni e / - td r/` Dishwasher 25.02
/ 0 /eel, C
• c. v I /���� Sd'` / Z ' 1 J Drinking fountain 25.02
Ai d_ ,,, ".1„,,,_ je ,, ,,/ / 5 ,2 e �. g it 5 Ejectors /sump 25.02
Ei PROPERTY OWNER f I ❑ TENANT Expansion tank 12.51
•
Name: Fixture /sewer cap 25.02
Floor drain/floor sirdc/hub S 25.02 /16'; /0 .
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
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory A 25.02 S 0 r 0 y'
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
' CONTRACTOR
Water heater / 37.52 3 7, SZ
Business name: z c ,./-,,, L 5 Pi fri4 6✓ (i t. a µ-r p zi is y Water piping/DWV 56.29
Address:V00 StJ el/32 Mid - 00 - 0 51 r Other: c s €. awl el f 0 25.02 25Z 20
City /State /ZIP: Po v it, 4 •. -,K 0 0I q 7a2 3 Subtotal 6 t/t
Phone: (903) 5 A (27a2 Fax: (�j) 8^9A .....„,/43 `? Minimum permit fee: $72.50
CCB Lic.: 1 S q�/ /6, Plumbing Lic. no.: p 8 �� Plan review (25° of permit fee)
State surcharge (12 /0 of permit fee) 64, ON
Authorized signature ), / ` I 71 I TOTAL PERMIT FEE .4 / 4. `r.7
r (j v This permit application expires if a permit is not obtained within 180 days
D /
Print name: - u .� �
E -1 Date:
after it has been accepted as complete.
\ `Fee methodology set by Tri -County Building Industry Service Board.
1 \ Building\Permits\PLMU- PermitApp.doc 10 /01/09 440- 46I6T(10 /02/COM/WEB)
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 6).7,200 $233.20
Sewer - 1st 100' 62.54 7,201 avid 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 Valuatidn• 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 Ins ections 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 ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to 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 (Fixture) Work Performed ❑ Any 'new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped • Added Existing engineer.
Baptistry/Font
Tub /Sowr • �� 12 New exterior plumbing site utilities for any complex structure
Bath - hower
Tub /S erlpool as defined in OAR918- 780 -0040.
11 Car Wash Each Stall Medical gas and vacuum systems for health care facilities.
Drive Stall El Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ 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 Isometric or Riser Diagram
Floor Drain/sink - 2" 5 ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
- 4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Maph./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory a-
- Bradley
- Commercial /f) *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a' sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes plumbing permit can be issued.
Water Extractor p g p
Water Closet - Toilet
Urinal
Other Fixtures:
1:\ Building \Permits\PLM- PermitApp.doc 2