Permit CITY OF TIGARD PLUMBING PERMIT
13_ COMMUNITY DEVELOPMENT Permit#: PLM2013 00272
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
Parcel: 2S 101 AD00800
Jurisdiction: Tigard
Site address: 12550 SW 68TH AVE
Project: Heintzberger/Payne Subdivision: WEST PORTLAND HEIGHTS Lot: 26
Project Description: Cap(1)sink. Relocate(1)dishwasher,(1)garbage disposal&(1)sink. Add(2)shower stalls.
Contractor: D&B PLUMBING, INC Owner: BHKZ LLC
PO BOX 686 12600 SW 68TH PKWY
OREGON CITY, OR 97045 PORTLAND, OR 97223
PHONE: 503-657-7423 PHONE: 503-546-4151
FAX: 503-657-7396
FEES
Quantity Description Date Amount
1 ea Dishwasher 08/08/2013 $25.02
Specifics: 1 ea Fixture/Sewer Cap 08/08/2013 $25.02
1 ea Garbage Disposal 08/08/2013 $25.02
Type of Use: COM 3 ea Sink 08/08/2013 $75.06
Class of Work: ALT 2 ea Tub/Shower/Shower Pan 08/08/2013 $25.02
Type of Const: 1 12%State Surcharge- 08/08/2013 $21.02
Occupancy Grp: Plumbing
Stories:
Total $196.16
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 que '_- •UNC by calling 503.232.1987 or 1.800.332.2344.
IssueN By: 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
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received Date/By: / Permit No.: P L Oe/ - D�7,2
• 13125 SW Hall Blvd.,Tigard,OR 97223
7 =, Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: / 7
T 1 GAR D Inspection Line: 503.639.4175 Date Ready/By: tuns: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist.
❑New construction ❑Demolition
Description I Qty. I Ea. I Total ',JI
VAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 F
❑ 1-and 2-family dwelling 'Commercial/industrial SFR(2)bath 437.78 b
CI Accessory building ID Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02 (�
❑ Master builder ❑Other:
Fire sprinkler( sq.ft.) I Page 2 fA
JOB SITE INFORMATION AND LOCATION Site utilities: (I
g 5-,/b t w 6(f' Catch basin or area drain 18.76 ls.
Job site address: y,V J D C
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Ile AtD 0 g7 223 Page Footing drain(no.linear ft.: ) Pa e 2 OO
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03 \
Cross street/directions to job site: Manholes 18.76
Q .*U ec 4 b DPP 22ND Sr Nettie Rain drain connector 18.76
�Aj ��/f~f 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.: a /(5/ 6--b 6O 300 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I lil TENANT Expansion tank 12.51
Name: He fou gR6a pofYNE Fixture/sewer cap / 25.02
Floor drain/floor sink/hub 25.02
Address: '2 S b sou era. Garbage disposal / 25.02
City/State/ZIP: 77 irpt#f d 0 f 17 2,7-1
Hose bib 25.02
Phone:(633 59-7- (62( Fax:(,5la'6/7 A?y Ice maker 12.51
❑ APPLICANT CONTACT PERSON/ Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
�.A f Primer 12.51
Contact name: �J( r
Roof drain(commercial) 12.51
Address: 12s 9.7 5w 6 g-tt Sink/basin/lavatory 3 25.02
City/State/ZIP: 1-76 O oR, q7 2 Solar units(potable water) 62.54
Phone:(�h'� 597_(6 z( Fax::(5 ,� "s-97.. (6 2� Tub/shower/shower pan g- 12.51
E-mail:�Pf to 0e tpNoRT}f VEsl. cam
Urinal 25.02
`'y CONTRACTOR -1 Water closet 25.02
Water heater 37.52
Business name: 47 fv
U,"6;‘,5 i ...iejC, Water piping/DWV 56.29
Address: /G ilyGx //< a
G Other: 25.02
City/State/ZIP: [//.3Oa, C1/) �)l'"? Subtotal /75, (41
Phone:(563) 65"7 75/Z3 (/ Fax:(5-03 ), 5,--7 7,79e Minimum permit fee: $72.50 - 7
CCB Lic.: L� 1/Q Plumbing Lic.no.: 5,/jy pe Plan review (25%of permit fee) �-
�� �/ ' State surcharge TOTAL of permit fee) 02t.��
Authorized signature: G% . TOTAL PERMIT FEE /9l�
Pnnt name: ,c/�' Date: This permit application expires if a permit is not obtained within 180 days
o�r/� /746 t•, after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PemritA.pp.doc 10/01/09 440-4616T(10/02/COM/WE B)
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
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace! Plan review is required for any of the following.Performed: Capped Added Relocate 9 y g'
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 11 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 1 ❑ 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"
4" Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related • I . that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall 2
Sink/Lav -Non-food related 1 2 1
-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_hal I/departments/cd/docs/PLM F-Perm i tApedoc
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12550 SW 68TH AVE, TIGARD, OR, 97223 2013 - 12 - 03 (null)
Record Type: Record ID:
Commercial - Plumbing PLM2013 - 00272
Inspection Type: Result:
399 Plumbing final PASS - No C of 0
Comments:
2 ea showers and 1 - ea lay roughed - in only. Permit required for completion in future.
Violation Summary:
Inspector Contractor