Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00276
TI G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
Parcel: 2S102AB02800
Jurisdiction: Tigard
Site address: 12475 SW MAIN ST
Project: Kiss Car Wash Subdivision:_LECTRIC ADDITION TO TIGARDVILLE Lot: PTS 1-9
Project Description: Replacing 60 ft.of water main.
Contractor: BRUNER PLUMBING Owner: THOMPSON, DENNIS C
PO BOX 23985 9295 SW ELECTRIC ST
TIGARD,OR 97281 TIGARD,OR 97223
PHONE: 503-484-5105 PHONE:
FAX: 503-624-2173
FEES
Quantity Description Date Amount
60 If Water Service 08/08/2013 $62.54
Specifics:, 1 12%State Surcharge- 08/08/2013 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 08/08/2013 $9.96
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: ` 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 ADplicationRECEIVE I
Building Fixtures 7 . ' FOR O'FFICI :USE O'�Ly
City of Tigard AUG LU13
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11114
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?/!3 7-, Permit No.: /
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.. . 13125 SW Hall Blvd.,Tigard,OR 97223 er )V of IGA0 Phone: 503.718.2439 Fax: 503.598.1960. Date/By: Other Permit No.:
T l G A t D Inspection Line: 503.639.4175 BUILDING DIVI SIONj Date Ready/By: _
�` IA See Page 2 for
. . - Internet: www.tigard-or.gov Notified/Method: Y`! Supplemental Information
TYPE 10P WORK _ , t•',. ,. FEE*'SCHEDUI;E _... ,. .
For special information use checklist.
❑New construction ❑Demolition
h Description ( Qty. [ Ea. I Total
❑Addition/alteration/replacement Other: tiJ/. ��}
71 R P'tA71 NI New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF;CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling Commercial/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
J.OB SITE IN_ FORMATION,AND LOCATION'' Site utilities:
Job site address: i a ti"7 s sw rlA I N Si, Catch basin or area drain 18.76
-n 61-AR� �� � /��� Drywell,leach line,or trench drain 18.76
�
City/State/ZIP: // Footing drain(no.linear ft.: ) Page 2
Suite/bldgiapt.no.: I Project name: KI,S S Co lttili Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
2 Ike Rain drain connector 18.76
4-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.: Backflow preventer 31.27
DESCRIPTION•O,F.;WORIC'>. Backwater valve 12.51
/Pe t y //` Clothes washer 25.02
C11 eN . Pi4 ( ( O W47eR P1�11) Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,'(,PROPERTY OWNER I ,, ❑ TENANT.; . ,,.f, Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
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
.' APPLICANT,' ®;=CONTACT PER SON Y Interceptor/grease trap 25.02
Business name: IS�V N e N.0�1 g ipj� Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: ri Fe►ceN _Roof drain(commercial) 12.51
Address: P.U, RCX 0 3l .5 Sink/basin/lavatory 25.02
City/State/ZIP: -776,.4.12 i) OP, q17 7 Solar units(potable water) 62.54
Phone:(Ca ) Li.. Lr'7 Fax::( ) Tub/shower/shower pan 12.51
E-mail: 7)/1 I Qvfcft PL-'J)113 1N� o COM Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7) co
/ Plan review (25%of permit fee) -
CCB Lic.: G!'7 ,./ Plumbing Lic.no.: ,/,�-1/k$' /�
D t �! State surcharge(12%of permit fee) T.--7d
Authorized signature: if TOTAL PERMIT FEE /f,j0
e �J This permit application expires If a permit is not obtained within 180 days
Print name: �'hY C�r ���[t!N Date: -f after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1.\Building\Permits\PLMU-PermitApp.doc 10/01109 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 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 Q i f
r 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
Qty.,, Fee(ea)' ;Total,: each additional$100.00 or fraction thereof to
Otheirinspections,or, e,6 '' and ineludin_$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
Rcinspcction Fccs 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: r e t-4
b s
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" :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.
-3"
4 Isometr1C:''Or`Riser Diagram"
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food s
g q g
Disposal -Domestic-food related 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
Sink/Lav -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:
I:UBuilding\Permits\PLMF-PermitApp.doc 02/24/2011 2 •