Permit CITY OF TIGARD PLUMBING PERMIT
'` �' COMMUNITY DEVELOPMENT Permit#: PLM2020-00172
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/4/2020
Tf :r,�\AL) g 113 e
Parcel: 2S102A600912
X-427 2,0 Jurisdiction: Tigard
Site address: 12125 SW 92ND AVE
Project: Lawson Subdivision: KIMBERLY ADDITION Lot: 12
Project Description: Adding half bath: (1)lay,(1)water closet and water piping. 5/19/20:REPRINT to add(1)lavatory.
Contractor: OWNER Owner: LAWSON, KAREN L
12125 SW 92ND AVE
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 04/24/2020 $25.02
Specifics: 1 ea Water Closet 04/24/2020 $25.02
56 Misc Other Fee 04/24/2020 $56.29
Type of Use: SF 1 12%State Surcharge- 04/24/2020 $12.76
Class of Work: ALT Plumbing
Typo of Const: 1 ea Lavatories 05/21/2020 $25.02
Occupancy Grp: 0 12%State Surcharge- 05/21/2020 $3.00
Stories: Plumbing
Total $147.11
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: ,,�� (� . Perrnittee 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 APPlicatiRECF FED
Building Fixtures q q FOR OI I I( I: I SF OAI.1
MAY 1 V 2020 Received -z -?4 +
City of Tigard Dale/BY �� ��'��/J�
5_ ■ 13125 SW Hall Blvd.,Tigard,OR 97 OF !CA,9D Plan Review
U . Phone: 503.718.2439 Fax: 503.,�� Date/By: Other Permit No.:
Inspection Line: 503.639.4175 ING DIVISION
I r �` 1 Internet: www.ti and-or. ov Date ed/MelReady/ o Juris. Supplemental See Page2 Ifnformation
s TYPE OF WORK FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
VAddition/altetation/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
�/ CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
Wl-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
El Accessory building Multi-family SFR(3)bath 500.32
❑
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 12125 SW 92 N D AVE. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard/Oregon/97223 Footing drain(no linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 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
lir DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Adding a bathroom sink to permit Dishwasher 25.02
number PLM2020-00172 Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTX, LVNJR.." 0 TENANT Expansion tank 12.51
Name: KG e r k 6-aeri,C.0ki Fixture/sewerFoordrain/floor
cap 25.02
Address: `A(Ls- Sw 72 Garbage
ge disposal
osasulkhub 25.02
�w� Garbage disposal 25.02
City/State/ZIP: 7-r C�d c/te vl� �3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 1 25.02
44 City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACFO ,
Water heater 37.52
Business name: (-__- t)/� r� Waterpiping/DWV 56.29
Address: � Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
Rick Lawson -- ---- ----- - State surcharge(12%of permit fee)
Authorized signature: ICicFt Lawson TOTAL PERMIT FEE
Print name: Rick Lawson Date: 5/16/2020 This permit application expires if a permit is not obtained within 190 days
after it has been accepted as complete.
*Fee methodology set by Tel-County Building Industry Service Board.
I\Building\Permas\PLMU-PennitApp.doe 10/01/09 440-4616T(10/02/COM/NEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total uare Foota.e: 't Fee:
Footing drain- I"100' 50.03 0 to 2,000 $1 21.90
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 S stems:
Water Service-each additional 100' 37.52
alUatiOn:
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
Other Insp ttlris or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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 PIUm"t1`ing" , ai"it
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
as defined in OAR918-780-0040.
-Drive Taro
ElCuspidor/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" ❑ 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 MachJRefrig.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 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:
L\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
CITY OF TIGARD PLUMBING PERMIT
1114
COMMUNITY DEVELOPMENT Permit#: PLM2020-00172
Date Issued: 05/04/2020
TIC;A RID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S102AB00912
Jurisdiction: Tigard
Site address: 12125 SW 92ND AVE
Project: Lawson Subdivision: KIMBERLY ADDITION Lot: 12
Project Description: Adding half bath: (1)lay,(1)water closet and water piping.
Contractor: OWNER Owner: LAWSON, KAREN L
12125 SW 92ND AVE
TIGARD, OR 97223
P
PHONE:
HONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 04/24/2020 $25.02
Specifics: 1 ea Water Closet 04/24/2020 $25.02
56 Misc Other Fee 04/24/2020 $56.29
Type of Use: SF 1 12%State Surcharge- 04/24/2020 $12.76
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $119.09
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: \r r
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 AuulicationR E 0 rz \/E D
Building Fixtures APR 2 0 2020
13125`y SW Ha of ll Blvd.,Tigard,OR 97223 CITY OF TIGARD Received
Date/B : 11/zy 4.)0 Permit No�L,%2O 2O -Ioo/'7.L4
liPlan Review
■ Phone: 503.7182439 Fax: 503.598.8 lLDING DIVISION DateJB-: Other Permit No.:
1 i G A R D Inspection Line: 503.639.4175 Date Ready/By: /, tuns' 65 See Page 2 for
Internet: www.tigard-or.gov Noticed/Method:// 0-0 4? Supplemental Information
TYPE OF WORK rL / FEE" SCHEDULE
0 New construction 0 Demolition t For special information use checklist
Description I Qty. I Ea. 1 Total
i-on/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for h utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
d 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 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: /1 I!5 5 ) ?'2 A/,P A U.z , Catch basin or area drain 18.76
G Drywell,leach line,or bona drain 18.76
City/State/ZIP:77(6 ?. �/ ?2/ 43 Footing drain(no.linear ft.:_J Page 2
Suite/bldg./apt.no.: `/•"' r Project name: Manufactured home utilities 50.03
Cross street/directions to job site:�.'� Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_I Page 2
Storm sewer(no.linear fl.:_j Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
��P/ l L.-1 -(� Clothessw wherher 25.02
.L !:'r-'~C' � t//7 �j+ Dishwasher 25.02
3 /,e24- ,�,ii ��/G�//L - Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
g7 ':G C. 1 Fixtureisewer cap 25.02
Name: /f j�l -��� 7�Q ������.../// J�� Floor drain/floor sink/hub 25.02
Address:�/2-/2.77 ,�'-e/ ! 2 1$tY�.- Garbage disposal 25.02
City/State/ZIP: 7`�C/�/��/ 0g; '-2�3 Hose bib 25.02
Phone: J�),1Z- 2__C) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory / 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet I 25.02
Water heater 37.52
Business name: Q�i ' Waterpiping/DW / 56.29
Address: VJ�ry Ir
Other: { 25.02
City/State/ZIP: Subtotal /44 C 33
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lie.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) /,74,
Authorized Signs. -' TOTAL PERMIT FEE //lr 499
Prtnt i Date. This permit application expires If a permit is not obtained within 18d days
�� after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
F\Building\PermitslPLMU.PertniApp.doc 10Po1/09 440-4616r(10/02/CAM/WEB)
fir
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-I"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 $t(0)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
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-12 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-12 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
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 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
❑ 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 Maeh./Refig.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:
1:1Building\Permits\PLMF PermitApp.doc 08/04/2011 2