Permit CITY OF TIGARD PLUMBING PERMIT
°7 'I ' - COMMUNITY DEVELOPMENT Permit#: PLM2020-00273
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/27/2020
Parcel: 1 S 133AD07800
Jurisdiction: Tigard
Site address: 12800 SW CHICORY CT
Project: HEBERT Subdivision: AMART SUMMER LAKE Lot: 122
Project Description: Shower pan installation.
Contractor: OWNER Owner: HEBERT, MICHAEL ALAN&POLLY ANN
MICHAEL ALAN&POLLY ANN HERBERT 12800 SW CHICORY CT
12800 SW CHICORY CT PORTLAND, OR 97223
TIGARD, OR 97223
PHONE: 503-619-5958 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 07/27/2020 $12.51
Specifics: 1 12%State Surcharge- 07/27/2020 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 07/27/2020 $59.99
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: 574-"""c".)14;;A,
n
v f�rJ
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 RECEIV vedB y: 7/// JA` Pen"
No.: /Ji M ] (7n-0b?7)
• 13125 SW Hall Blvd.,Tigard,OR 97223 aatc/By: ((//f/V /`�FJsIS'� �-LJ� ��/(/OV VP
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 q q Date,/By: Other Permit No.:
Inspection Line: 503.639.4175 JUL 1 6 2021 - ---
t I G A R t) Date ReadyMy: Jura: ® See Page 2 for
Internet: www.tigard-or.gov - - i it al ified/Met'tnd.: _ Supplemental Information
TYPE OF W 0 "� FEE* SCHEDULE
ar ar
0 New construction • Demo Ilion For special in urination use checklist.
NtqlDescription Qt . Ea. Total
Addition/alteration/rtplacemem ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
---,• .,, t TEGORY OF 0:it t SFR(1)bath 312.70
1I: 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
------- - - ------J SFR(3)bath 500.32
❑Accessory building ❑Multi-family - -
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Pagc 2
,y ,_ •T `� i Site utilities: - - -
Job site address: ' �,IdJ 0 _, t C h , G r' Y Catch basin or area drain 18.76 ail
`3 r Drywell,leach line,or trench drain 18.76
T
City/State/ZIP:
,�_ -- - ----- Footing drain(no.linear(I.:__) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: .S U �.�( �r fF 9 n1. Manholes 18.76
r t-P Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
f Water service(no.linear ft.:_) Page 2
Subdivision: 5 Am tv e 1,, � 4 l\.P Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
Clothes washer 25.02
4 1 1 ,i S d W e r p�{(7 Dishwasher 25.02
` Drinking fountain 25.02
• t - 222. Ejectors/sump 25.02
.I t • a' ' Expansion tank 12.51
• u j,. - Fixture/sewer cap 25.02
Name: F'' - li any b1 \ I ekto(
Fg 0 W chi
G a r c-� Garbage
ge spo sink/hub 25.02
Address: disposal 25.02
City/State/ZIP:Ti qrq 7 2,LI Hose bib 25.02
Phone:( 3) 6`j I 5�1pi\ Fax:( ) 1 Ice maker 12.51
7 1 0 a Interceptor/grease trap 25.02
Business name: �J tt�,`, Medical gas(value:$_) Page 2
lab H�beY� - Primer 12.51
Contact name: --
Roofdrain(commercial) 12.51
hAddress: 2$D S Gh/C ry C11 Sink/basin/lavatory 25.02
c City/State,/Z1P:77 q ar`' O K 4 -/_,-/`2 Solar units(potable water) 62.54
I' Phone:(.3) ,)Q , t.l o iFax::( ) Tub/shower/showerpan 12.51 x fi'
NI. E-mail: Urinal 25.02
>..7.: Water closet 25.02
Water heater 37.52
Business name: ifaV I I' Qb e r r ,{� Water piping/DWV 56.29
Address: /y' O O SE.
IV ii)h J !K dN� Other: 25.02
, City/State/ZIP: I 1 loin Y ' R v 9726 j-� Sf h Subtotal
Q \ v Minimum permit fee: $72.50 7.2.
Phone:( 31 7�4 I Fax:( )
Plan review (25%of permit fee)
ezz CCB Lic.:1 7/ Plumbing Lic.no.:
/� �/l� State surcharge(12%of permit fee)
Authorized sign e•� /�/t��,/f111,-,l' . TOTAL PERMIT FEE
Print na . f , �A`la r N I& r1- Date:7//y 1,7,0 This permit application expires if a permit is not obtained wi n 180 days
`�+�1• 1i after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
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Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Sup ression Systems:
Site Utilities Qty. Fee(ea) Total quare Footage: - t Fee:'..
Iboting drain- ` 100 50.03 0 to 2,000 $121.90
Footing drain-each additional IOU' 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 - -- ---"-"-
Storm&Rain Drain-1st 100' 62.54 Valuation: 1 Permit peer
$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
t each additional$100.00 or fraction thereof,to
Other Inspections 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 90.00hrr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.0010r $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 " ". r ing; IlationS
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
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru 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 El Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
hyc Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regardingfixture work:
Oil Separator(Gas Station) T e Q a�, 6 r f t�° (� i sfd ed
Rec.Vehicle Dump Station the s tie) er ra [-� l- +, e nQ-I hie
Shower: -Gang t• 1, d, e vote
c_ Y c I I
_stall l�' w � n e T � � �� w ct l�
Sink: -Lav/Bar non-food related 1 l 14> O VQ r e (w or / n 5kp (t
-Bradley r a n r 5-
-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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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