Permit CITY OF TIGARD PLUMBING PERMIT
MI 2 COMMUNITY DEVELOPMENT Permit#: PLM2020-00395
ES
Date Issued: 10/1/2020
TttAI D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 I '
Parcel: 2S103CD02600
Fr").' Jurisdiction: Tigard
Site address: 13780 SW 116TH PL
Project: Schelsky Subdivision: HOLLYTREE Lot: 6
Project Description: (1)new shower for master bathroom remodel. 10/22/20: REPRINTED permit to include(2)hose bibs.
Contractor: VENNE PLUMBING LLC Owner: SCHELSKY, MURIEL A TRUST
15145 SW DIVISION ST 21550 SW 75TH AVE
SHERWOOD, OR 97140 TUALATIN, OR 97062
PHONE: 503-624-9309 PHONE:
FAX: 503-684-0940
FEES
Quantity Description Date Amount
2 ea Rain Drain Connector 10/01/2020 $37.52
Specifics: 2 ea Hose Bib 11/01/2020 $50.04
1 ea Tub/Shower/Shower Pan 10/01/2020 $12.51
Type of Use: SF 1 12%State Surcharge- 11/01/2020 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.08
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:
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 Application Date: Permit Number: f‘'Li"J 11439S-
City of Sherwood www.sherwoodoregon.gov !��F P
22560 SW Pine Street, Sherwood,OR 97140-8330 Phone: (503)625-4226 Fax: (503-625-0629)
Sherwood 24-hour Inspection Request: (503)625-0545 E-Mail:huilding@sherwoodoregon.gov 0 C T , 9
Oregon _
TYPE OF WORK FEE SCHEDULE
D New construction ❑ Demolition
For special information,use checklist,
D Addition/alteration/replacement ❑Other: Description Qty. Ea. Total
CATEGORY OF CONSTRUCTION New 1-2-family dwellings(includes 100 ft.for each utility
SFR(1)bath $305.10
❑ I-and 2-family dwelling 0 Commercial/industrial
SFR(2)bath $376.89
❑Accessory building 0 Multi-family SFR(3)bath $448.68
❑Master builder 0 Other: Each additional bath/kitchen $185.46
JOB SITE INFORMATION AND LOCATION Fire sprinkler(_sq.ft.) ++
Job site address: Site utilities
Catch basin or area drain $17.95
City/State/ZIP: Drywell,leach line,or trench drain $17.95
Suite/bldg./apt.no.: Project name: Manufactured home utilities $35.89
Description of Work: Manholes $17.95
Rain drain leaders $17.95
Subdivision: Lot no.: Footing Drain (no.linear ft.: $59.82*
Sanitary sewer(no.linear ft.: $59.82*
Tax map/parcel no.: Storm sewer(no.linear ft.: ) $59.82*
0 ARCHITECT/DESIGNER ❑ ENGINEER Water service(no.linear ft.: ) $59.82*
Business Name: Business Name: Fixture or item
Contact: Contact: Backflow preventer $17.95
Phone: Phone: Backwater valve $17.95
Clothes washer $17.95
E-mail: E-mail:
Dishwasher $17.95
0 PROPERTY OWNER 0 TENANT Drinking fountain $17.95
Name: Ejectors/sump $17.95
Address: Expansion Lank $17.95
City/State/ZIP: Fixture/sewer cap $17.9595
Floor drain/floor sink/hub $ 17.95
Phone: Fax:
❑ APPLICANTGarbage disposal $17.
0 CONTACT PERSON Hose bib p $17.95
Business name: Ice maker $17.95
Contact name: Interceptor/grease trap $17.95
Address: Medical gas(value:$ )++
Primer $17.95
City/State/ZIP:
Roof drain/overflow drain $17.95
Phone: Fax::
Sink/basin/lavatory $17.95
E-mail: Tub/shower/shower pan $17.95
\ CONTRACTOR Urinal $17.95
Business name:VI 1� -� RIY 1 VJ \ Water closet $17.95
Address: Water heater $17.95
Other:
City/State/ZIP: Subtotal
Phone: Fax: Minimum permit fee=$72.83
E-mail: (� \ � j__ i! Mic.(w/exP.):
Plumbing. lie.: (If Required) Plan review(30%of permit fee)
CCB lift(wlexp. : 22 l State surcharge(12%of permit fee)
// TOTAL PERMIT FEE '.
Authorized signa ure: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
Print name: / � Date: ,2�' *559.82 for the first100 lineal feet or fraction thereof plus$32.91 each
additional 100 lineal feet or fraction thereof.
a
Dianna Ornelas
From: #Building Permit Technicians
Sent: Tuesday, October 27, 2020 3:40 PM
To: Office
Cc: Branden Taggart
Subject: RE: FW: plumbing permit: PLM2020-00395 - 13780 SW 116th PI.
Importance: High
Hi Kelley,
I am just following up on the payment of$30.88 for this permit that was ready last Thursday. I just don't want to miss
anything and make sure that you receive this revised permit, so please email us as soon as you have made the payment
and we will email you the revised permit.
Thanks!
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: Branden Taggart<brandent@tigard-or.gov>
Sent:Thursday, October 22, 2020 1:03 PM
To: Office<venneplumbing@gmail.com>
Cc: Dianna Ornelas<Dianna@tigard-or.gov>
Subject: RE: FW: plumbing permit: PLM2020-00395 - 13780 SW 116th PI.
Importance: High
Hi Kelley,
I have added (2) hose bibs to your existing permit: PLM2020-00395. The balance due is$30.88, and I have attached an
invoice above for you to reference. The permit fees can be paid online through our
website: https://aca.accela.com/tigard/Default.aspx. From there, click on the Building tab, enter the permit number
(PLM2020-00395) in the Record Number field, and click Search. Once paid, please notify us at
TigardBuildingPermits@tigard-or.gov, and I will email the revised permit paperwork to you.
Thanks,
1
CITY OF TIGARD PLUMBING PERMIT
• a ; COMMUNITY DEVELOPMENT Permit#: PLM2020-00395
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/1/2020
Parcel: 2S103CD02600
Jurisdiction: Tigard
Site address: 13780 SW 116TH PL
Project: Schelsky Subdivision: HOLLYTREE Lot: 6
Project Description: (1)new shower for master bathroom remodel.
Contractor: VENNE PLUMBING LLC Owner: SCHELSKY, MURIEL A TRUST
15145 SW DIVISION ST 21550 SW 75TH AVE
SHERWOOD, OR 97140 TUALATIN, OR 97062
PHONE: 503-624-9309 PHONE:
FAX: 503-684-0940
FEES
Quantity Description Date Amount
2 ea Rain Drain Connector 10/01/2020 $37.52
Specifics: 1 ea Tub/Shower/Shower Pan 10/01/2020 $12.51
1 12%State Surcharge- 10/01/2020 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 10/01/2020 $22.47
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 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: A
cwo
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.
Building Fixtures 1a
w ' • Fcxz otI'1cF, > til. o�L
I Of Tigard x•' `• _.• ..- Receivedi Perrot Ne.:
g d Date/By: Tf / y,( /� � �/
II • 13125SW Hall Blvd.,Tigard,OR 97223 1 Review
lvV =�� ' •�
ti Phone: 503.718.2439 ax: 503.5 Il 611 U 2020 pane.Byiew Other Permit No./220-+ tti 4//!
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Inspection Line: 503.639.4175 • _! _ ";-..I,:-) Date Ready/By: Jury: See Page 2 for
TIGARD Internet: www.tigard-or.gov I f j 1�.X i'".`': �i Notified/Method: � Supplemental Information
TYPE:A ,VV4 \ ?. 1��'1 �.`,llV FEE* SCHEDULE
0 New construction 0 Demolition For special informa9on use checklist
Description I Qty, I Ea. I Total
..Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
31"1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family 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: 131 g® \,( 114 t sa: Catch Basin mama drain 18.76
t1 12 Drywell,leach line,or trench drain 18.76
City/State/ZIP: r� C �._p O' ..
1�V Y"�r-+� !/� Footing drain(no.linear ft.: ) Page 2
Suitelbldg./apt.no.: I Project name: 5C�14 � Manufactured home utilities 50.03
Cross street/directions to job site: /y� Manholes �7 18.76
iiiieff)/ l At/'7Zc /"v/� �lXli/� a !u//` Rein drain connectar L_ 18.76
�` W ^r�' _Sanitary sewer(no.linear ft.: ) Page 2
"-eta e Purr �✓l crr ? Cv ju+'�17 /t . . ° Storm sewer(no.linear ft.: ) Page 2
/0/i/ _/.j- Water service(no.linear ft.:_j Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
a�M f� � �. Clothes washer 25.02
q�I'*V,J' (\ )..1 G1,() 5t 4 e_ poo-rots. Dishwasher 25.02
2F \is 2�,� siei ,B i ii. Drinking fountain 25.02
*•L" -kolAIfl4Kt AriPiAK�-, •i �"ciectots/sump 25.02
0 PROPERTY OWNER I 0 TENANT .9 Expansion tank 12.51
Name: i5 C Pram `1 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
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name: 12.51
Primer
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 l 12.51
Urinal 25.02
E-mail:
Water closet 25.02
A � {- Water heater 37.52
CONTRACTOR
Business name: JG, t 4J .- �V C1 Water piping/DWV 56.29
Address: \'S ` , 5l N )t\V\S b N Other: 25.02
City/State/ZIP: k 0 C1 1 1-.(0 Subtotal y�
\ Pax:( ) Minimum permit fee: $72.50 72,sI/
Phone:( s) �(t_(� Plan review (25%of permit fee)
CCB Lie.: t(�L(( L'j U .. , Plumbing Lic.no.: p q e
)�5/- State surcharge(12%of permit fee)
Authorized signature: g -- TOTAL PERMIT FEE Q?I- 2 r)
1 +,G h6. Date: (+�I 1 2h They permit application expires if a permit is not obtained withi�/ia0 days
Print name: l_ v c [" ���` JJJ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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