Permit (165) IIIIIICITY OF TIGARD PLUMBING PERMIT
N . COMMUNITY DEVELOPMENT
Permit#: PLM2016-00563
13125 SW Hall Blvd.,Ti Date Issued: 11/16/2016
T[Cza'�S .L'a and OR 97223 503.718.2439 9
Parcel: 2S102CC06400
Jurisdiction: Tigard
Site address: 13605 SW GARRETT CT
Project: Burns Subdivision: BEREA Lot: 28
Project Description: Replacing existing shower with new.
Contractor: WHITTINGTON &SONS PLUMBING COMPANY Owner: BURNS, MICHAEL L AND
6375 SW CHERRYHILL DR ALICE DIANE
BEAVERTON, OR 97008 13605 SW GARRETT
TIGARD, OR 97223
PHONE: 503-536-5910 PHONE:
FAX: 503-648-0617
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 11/16/2016 $12.51
Specifics: 1 12%State Surcharge- 11/16/2016 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 11/16/2016 $59.99
Class of Work: ALT Plumbing
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 4 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 ad..ted by the Oregon
Utility Notifitatio enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-00 -0090., Yiu may obtain a copy of the rules
or d'ect questions to O C b .fling 503.232.1987 or 1.800.332.2344.
, ,___
I sued By: so Permittee Signature: '
ill
Call 503.639.4175 by 7:00 a.m.for the next available inspector rr ate.
This permit card shall be kept in a conspicuous place on the job site until co •letion the project.
Approved plans are required on the job site at the time of each inspectio..
Plumbing Permit Application
Building Fixtures s ;t,,., k 9
1. F
City of Tigard ez- ' -J- Received /_ �^
ill 11111
13125 SW Hall Blvd.,Tigard,OR 97223
Date/By: 1/ //e IV Permit No.: Lf(9-eik-ex,6-63
_ Phone: 503.718.2439 Fax: 503.5 1 Plan Review
q 0( n 1Other Permit No.:
`� 3 u (U(Ulu
Date/By:
T I Ci A R D Inspection Line: 503.639.4175 Date Ready/By: furls: H See Page 2 for
Internet: www.tigard-or.govi Notified/Method: Supplemental Information
TYPE OF ' Of 1 i iii.KU *
FEESCHEDULE
❑New construction T '° 1 '1 '-'7,-' °i�� For special information use checklist.
Description I Qty. Ea. Total
Ei Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION; Site utilities:
Job site address: 1 3(a i 5 W ( ��eii/( �/7. ,vim* c+ -f _ Catch basin or area drain 18.76
•
City/State/ZIP: jt
u lr\ (� Drywell,leach line,or trench drain 18.76
r' Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: noi" (Qin/�`, cyte
s 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 1,h, Backwater valve 12.51
q 0,'ILO
f 12 �1 tJ7) {A/A ( /' J/� �(c1� Dishwasherothes 25.02
�f '1 l il211( '�l(� `((��fJ Dishwasher 25.02
SDrinking fountain 25.02
t,=
Ejectors/sump 25.02
0 PROPERTY TEh ANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
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
9. ❑ PLIC {`` ?. t CO*7TAC,T PERSON i,"' Interceptor/grease trap 25.02
Business name: J ' r , Medical gas(value:$ ) Page 2
Contact name: 1 < < + �- Pnmer 12.51
1 Roof drain(commercial) 12.51
Address: r-, `,��®
-�p� CA � , ,,\.._.,\\ �K-� Sink/basin/lavatory 25.02
City/State/ZIP: hj v\7\----. � 1 RvvA Solar units(potable water) 62.54
Phone:(3,3 ) "')310 _ C C.1 l) , Fax::(5,GL11 lI) (Ljc(.,-(3(0/1-' Tub/shower/shower pan i 12.51
E-mail: " Urinal 25.02
Water closet 25.02
1 CONTRP�.CTOR., i:`
L
� t� Water heater 37.52
Business name:a J
r, -5 • 6Water piping/DW V 56.29
Address.,, CliX- - Other: 25.02
City/State/ZIP: V. l J� R v Subtotal
7 4-
Phone:O C.;,?..-10 - b _ Fax:( ) Minimum permit fee: $72.50 7a
•
CCB Lic.: -Ct Pl y (_2Cj Plan review (25%of permit fee)
ing Lic.no.: ` `(�>
I State surcharge(12%of pennit fee) 2.70
Authorized gnatur
V_ ( I� TOTAL PERMIT FEE 2./.
Print name: I f � , ,te. I tf i , This permit application expires if a permit is not obtained within 180 days
tiafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
,%
I:\BuildmgTermits\PLMU-P itApp.doc 10 t /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 Qtr. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1s'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
Qty Fee(ea) total% each additional$100.00 or fraction thereof,to
OtherInspections or Fees 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*. Plan Review for Plumbing Installations
Quantity 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 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3„ IsQmctric orRiser Diagram
4"
0 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: -Lav/Bar 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 be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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