Permit U CITY OF TIGARD PLUMBING PERMIT
1 • COMMUNITY DEVELOPMENT Permit#: PLM2013-00321
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718.2439 Date Issued: 09/16/2013
Parcel: 2S 1108804000
Jurisdiction: Tigard
Site address: 12165 SW AMES LN
Project: PETERSON Subdivision: ARLINGTON RIDGE Lot: 17
Project Description: New tile shower
Contractor: EMPIRE PLUMBING LLC Owner: PETERSON, BRYCE D& KRISTI A
19572 SW TREEHOUSE LN 12165 SW AMES LN
BEAVERTON, OR 97007 TIGARD,OR 97224
PHONE 971-506-6354 PHONE.
FAX
FEES.
Quantity Description Date Amount
2 ea Tub/Shower/Shower Pan 09/16/2013 $25.02
Specifics: i 12%State Surcharge- 09/16/2013 $8 70
Plumbing
Type of Use: SF 47 ea Minimum Fee Adjustment- 09/16/2013 $47 48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81 20
Required Items and Reports(Conditions)
A
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of 3R. Sp• Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if w• k is • arted within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to fol• the - adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 ou = '.btain a copy of the rules
or direct questions to OUNC by calling 503.232 1987 or 1.800.332.2344.
Issued By: ermittee Signature:
1
V
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
, � Received _
City of Tigard i i '.,,.T raj Date/By: Permit No.. /L
li lIl V 13125 SW Hall Blvd.,Tigard,S1,:,.,tb.,„- flea
Phone: 503.718.2439 Fax: 50',5':.19(()p 4 Plan Review
�` �� ® Date/By: Other Permit No.:
i'I G n R D Inspection Line: 503.639.4175 Cj -( Date ReadyBy: luris: ® See Page 2 for
Intemet: www.tigard-or.gov (�( \�G,`S®�� Notified/Method: "�Jy, Supplemental Information
TYPE OF WORKCJ�� v�C�, FEE* SCHEDULE
❑New construction ❑ Ilion For special information use check!isL
Description I Qty. I Ea. I Total
AAddition/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 ❑Comercial/industrial SFR(2)bath 437.78
m
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: /A) $'5 .¢riles 60,7 Catch basin or area drain 18.76
� Drywell,leach line,or trench drain 18.76
City/State/ZIP: //�4l l Oft- 17,7,i y Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: J I Project name: 'Pe'.1.-.e rSpv1 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
i\!t,c.0
( 'I e 54O`v¢,C- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: B f 1r e P e ge_50 pi Fixture/sewer cap 25.02
�oZ/ !4 Floor drain/floor sink/hub 25.02
Address: s W W vv1 e 5 �.tq-•t e_
Garbage disposal 25.02
City/State/ZIP: Fif Ott./ ' 722Y Hose bib 25.02
Phone:(503 ) 330 - ('57Q Fax:( ) - Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
�p 1 , Medical gas(value:$ ) Page 2
Business name: R t.V i✓+� �,r�✓ - e, .-G
Primer 12.51 _
Contact name: rc�' _ Roof drain(commercial) 12.51
Address: qvc
(i�a 5 S ' /5� Sink/basin/lavatory 25.02
City/State/ZIP: j-3 Je-K/°'✓1 e)/(__ 170®7 Solar units(potable water) 62.54
Phone:(5Z3 ) S?6-(0(0'6C) Fax::( � ) x Tub/shower/shower pan 12.51 g S_0,1 E-mail: / `-Urinal 25.02
ONTRACTOR Water closet 25.02
�� /7 Water heater 37.52
Business name: gvv\r' r'!A✓►'l h rrlvc1 Water piping/DWV 56.29
Address: ,C{s , t, , "fret!fp"i^y..... Lpq>✓ Other: 25.02
7 Subtotal /Z5,Vol
City/State/ZIP: . KlJ G'.,- QJ700
Phone:(563 ) Y• I- ' 4 - G 35 Fax:( ) Minimum permit fee: $72.50 7a.5)
CCB Lic.: C(7 e9 t Plumbing Lic.no.: P13 ), (iY eZ Plan review (25%of permit fee)
State surcharge(12%of permit fee) a-7ci
Authorized si;t atur,: TOTAL PERMIT FEE $1-yp
Print name: I Date: // 16/r3 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:\Building\Permits\PLMU-PermitApp.doc 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-151 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001.to,3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
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&RainDrain-1st 100' 62.54
i $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 thefirst$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 ,
Quantiy 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
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Staall ❑ New exterior plumbing site utilities for any complex structure
Drive Tni 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
-4„ .El Isometric,or'riser diagram is required•for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal:. -Domestic food related .,• ,
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang '
-Stall _
Sink: -LavBar 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 lies issued and
Washer:Clothes fees assessed for the sewer increase must be paid before the
WaterExtractor
Water'Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures: •
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