Permit CITY OF TIGARD PLUMBING PERMIT
11,1
COMMUNITY DEVELOPMENT Permit#: PLM2020-00421
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19l2020
Parcel: 1 S133DA02700
Jurisdiction: Tigard
Site address: 12825 SW GLACIER LILY CIR
Project: Meredith Subdivision: AMART SUMMER LAKE Lot: 49
Project Description: Replace tub,shower and vanity sinks in master bathroom.
Contractor: OWNER Owner: MEREDITH, MICHAEL D&KATHLEEN M
12825 SW GLACIER LILY CIR
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Lavatories 10/19/2020 $50.04
Specifics: 2 ea Tub/Shower/Shower Pan 10/19/2020 $25.02
1 12%State Surcharge- 10/19/2020 $9.01
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: !\` `1::\\ Permittee Signature: /�.� c`�p`; C", U h
�� (, Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 1
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 f)
Building Fixtures FOR OFFICE USE ONLY
x
City of Tigard t . R:- rued Permit t
III
- 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: r 21J 4C� °P ZO'jC�� i'2
Plan Revi ew
Phone: 503.7182439 Fax 503.598.1960 1iir 22020 pat�gy Other PermitNo.:
Inspection Line: 503.639.4175 Date Read /B 1 fads: PI See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method:10 iq�zr, /�1 L Supplemental Information
TYPE OF WORK F719f(, Al/C4 l.FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description ( Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
1-and 2-family dwellingSFR(2)bath 437.78
bath
0 Commercial/industrial
❑Accessory building 0 Multi-family
)
Each ad SFR(additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft) Page 2
JOB SITE INFORMATION AND LOCATION Text Site utilities:
Job site address: 1A 8: 5' j t,,v 6- 1 e 7 v /; 'W itI e Catch basin or area drain 18.76
City/State/ZIP: T1.5 w-r'A O 9 7 2 2 3Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Bq-f-,Y'ty6 Re F.,ode 1 Manufactured home utilities 50.03
Cross street/directions to job site: S.'Lt/ NOYf-io'v Vako-E'4. Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear R: ) 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 Backwater valve 12.51
Replace -�" o , 5 �ow " r -✓,1-( 9 c Clothes washer 25.02
d V a ' lvS Dishwasher 25.02
1 n rY,4 suer ba+Fh-rob w1 Drinking fountain 25.02
Ejectors/sump 25.02
a PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: t'1 ic Ina?i /nev-edrf
Fixture/sewer cap 25.02
Address: 12 11 5 5.1"/ G I n.C l'2-r 4 l y C 1 r-c Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: 7,'r5e rr1 oR 9722 3 `/,1146
Hose bib 25.02
Phone:(93 ) 9 3 -3 S `Y9 Fax:(503 )S?(o -3g 3 7 Ice maker 12.51
IS APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
a7 W t1^P'r
Primer 12.51
Contact name: e,4r ne,r
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory a 25.02 ,S'e-0 y
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan a 12.51 Q5%02
� Urinal 25.02
E-mail: /IA CI M2,re,cr//t 7111{IP_ 1M.G2 I-1 t Cork"--
Water closet 25.02
CONTRACTORWater heater 37.52
Business name: 5 e 14. C1.4w✓W Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 7 C.d(,
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) /8 7 7 7T
CCB Lie.: Plumbing Lic.no.:
State surcharge(12%of permit fee) 9.00
Authorized signature: •,-,,,i,i.,1, i ,a. /h unJy TOTAL PERMIT FEE l0a.8 3
Print name:AN i c ha e I D fvte pact 1+t1 Date:Qt.t 6 1'2 This permit application expires if a permit is obtained within 180�Vie
after it has been accepted as complete. /7(. 7
*Fee methodology set by TB-County Building Industry Service oard.
I:1Building1PermitalPLMl1-PernutApp.doc 10/O1/09 440.4616T(10/02/COM/WBB)
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-l' 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' 62s4 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 I00' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty Fee(ea) Total
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
IDAny new commercial building with water service 2"and
Baptistry/Font -Tub/Shower greater,except systems designed and stamped by licensed
Bath:
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 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
Eye 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 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
-ComlServ/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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