Permit CITY OF TIGARD PLUMBING PERMIT
g COMMUNITY DEVELOPMENT Permit#: PLM2013-00369
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2013
Parcel: 1 S133DC08500
Jurisdiction: Tigard
Site address: 11740 SW 134TH TER
Project: Fossholm Subdivision: WINTER LAKE Lot: 15
Project Description: Replace approximately 60'of PVC water service with Wirsbo tubing. Add(1)pressure reducing valve.
Contractor: WATSON PLUMBING CO. Owner: FOSSHOLM, DAVID J&AMANDA K
7935 E BURNSIDE ST 11740 SW 134TH TERR
PORTLAND,OR 97215 TIGARD,OR 97223
PHONE: 503-313-5802 PHONE:
FAX:
FEES
Quantity Description Date Amount
60 If Water Service 10/21/2013 $62.54
Specifics: 25 Misc Other Fee 10/21/2013 $25.02
1 12%State Surcharge- 10/21/2013 $10.51
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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 direc estions o tt. NC by calling 503.232.1987 or 1.800.332.2344.
Iss ed 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.
p-
Plumbing Permit Application
Site Utilities I OR OFFICE USE ONLY •
, ?ELY t I City of Tigard Received �Q� �/�
g
Date/By: r 69/ / ' Permit No.: , r/it7l 3,0 6,9
a 13125 SW Ha11 Blvd.,Tigard,OR 9720C 2 1 2013 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: Juris: V1 See Page 2 for
Internet: www.tigard or.gov ^rV����rff 1 1 (Ea, Notified/Method: Supplemental Information
TYPE OF V1�ORKDING D'I V ISIO FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteratio replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
v] l-and 2-family dwelling ❑Comerciallindustrial 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:
// d CC / ' i/t Catch basin or area drain 18.76
Job site address: /17 7 ,/- 3 a✓ Drywell,leach line,or trench drain 18.76
City/State/ZIP: "7-41.9-r- 0 i2 9 7 as 3
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 5 p SS k0 l 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.:tp_Q) Page 2
Subdivision: I I,ot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
- DESCRIPTION OF WORK
� L J Clothes washer 25.02
t./�-L4- �wia.f'5t A/c- GV/d-fe� Ile-vt�- Dishwasher 25.02
GO kb-es do /(,r /�yVV Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
/ Fixture/sewer cap 25.02•Name: /�/17�}/�Jf/9- S-.0.5-5-fj 8 L/77 Floor drain/floor sink/hub 25.02
Address: Si-yvl e ,/-,j 0-e) ,Sri/-C- Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
. Q APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: j/9- (J-/�/ i ,Y+'1�j/X/g Medical gas(value:$ ) Page 2
/n 9 Primer 12.51
Contact name: i S( Roof drain(commercial) 12.51
Address: 7 3 $- 2„,,,,c,Yd 2_ Sink/basin/lavatory 25.02
City/State/ZIP: ,Opyt L� -t.xj ,, 0-y1.- 9762/5- Solar units(potable water) 62.54
Phone:(57)3) 3 13 -5-80 2- Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
CONTIRACTOR Water heater 37.52
Business name: Water pipin WV 56.29
Address: Other: �Q� 25.02 alS•4.-
City/State/ZIP: Subtotal
Phone:( ) Fax ( ) 7,t`tcg Minimum permit fee: $72.50 = ry7.5(0
//I ASS �I 67,-61%2 Plan review (25%of permit fee) �-
CCB Lic.: rl I I Plumbing Lic.no.:o2 - Pia
c---� State surcharge(12%of permit fee) / •`(
Authorized signature: - ✓�c--L�W TOTAL PERMIT FEE C�$„ C'1
X This permit application expires if a permit is not obtained within 180 days
Print name: to �Sr�N�Qy���,. Date: /6 dZ)-�3 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) - 1-ID A A ( '&l c2.
.44
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
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
Sewer-each additional 100' 7,201 and greater $327.54
37.52
Water Service- 1st 100' 62.54
Water Service-each additional 100' 37.52 Medical Gas Systems:
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
Storm&Rain Drain-each additional 100' $1.00 to$5,000.00 Minimum fee$72.50
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
Inspection of existing plumbing or for and including$10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including$25,000.00.
hours(minimum charge-2 hours) $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
Reinspection Fees 90.00/hr each additional$100.00 or fraction thereof,to
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/
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 OAR9I8-780-0040.
Eye Wash
Floor Drain sink 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
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
Washer-Clothes - *Note: If the fixture work under this permit results in an
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:\Building\Permits\PLMU-PermitApp.doc 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
11740 SW 134TH TER, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
2013-10-25 09:01:00
PLM2013-00369
PASS - No C of O
Violation Summary:
Inspector Contractor