Permit Support Document 13111 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00449
Date Issued: 11l6l2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102CA00922
PI PT.j , Jurisdiction: Tigard
Site address: 13225 SW VILLAGE GLENN DR
Project: 13225 SW Village Glenn Circle Subdivision: VILLAGE GLENN Lot: 22
Project Description: Remove galvanized pipse from water system and add 1 sink drain. 12/29/20:REPRINTED permit to include(1)
dishwasher,(1)garbage disposal,and(4)sinks.
Contractor: JAYBEL CONTRACTORS LLC Owner: LUM, MONIQUE
710 SW MCLOUGHLIN BLVD 13225 SW VILLAGE GLENN CIR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-985-9093 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 If Water Service 11/06/2020 $62.54
Specifics: i ea Water Piping/DWV 11/06/2020 $56.29
1 12%State Surcharge- 11/06/2020 $14.26
Type of Use: SF Plumbing
Class of Work: ALT 1 ea Dishwasher 01/06/2021 $25.02
Type of Const: 1 ea Garbage Disposal 01/06/2021 $25.02
Occupancy Grp: 1 ea Sink 01/06/2021 $25.02
Stories: 3 ea Lavatories 01/06/2021 $75.06
0 12%State Surcharge- 01/06/2021 $18.01
Plumbing
Total $301.22
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
Issued By: �� Permittee Signature: coal.. /„ _ ...
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. f/! "`/�
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.
x
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY City of Tigard Received Penult No.: PLM2020-00449
III • 13125 SW Hall Blvd.,Tigard,OR 97223 OEC 2 2020 Date/By:_ Phone: 503.718.2439 Fax: 503.598.196 Plan Review Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Read/B tuna RI See Page 2 for
TIGARD Internet: wwwti and-or. ov y y g
g' g NotifediMethod: Supplemental Information
TYPE OF woRW ®:' T tt FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
Q Addition/alteration/replacement ❑Other: . !tra New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTIO / a„`'..-, SFR(1)bath 312.70
C 1-and 2-family dwelling ElCommerci'Y ra trial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-fami
Each additional bath/kitchen 25.02
❑ Master builder El Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE-INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
13225 SW Village Glenn Circle Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223
g Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 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
ater service(no.linear ft.:3D ) j Page 2
Subdivision: Lot no.: ixture or item:
Tax map/parcel no.: Backflow preventer 31.27
_ r='
. i Backwater valve 12.51
,' _,, ,... ON OF WORK l Clothes washer 25.02
Replaced g lveni7ed with pex phlmhing, replaced sink. installer Dishwasher 1 25.02 25.02
dishwasher Drinking fountain 25.02
Ejectors/sump 25.02
] PROPERTY OWNER ❑ 'TENANT Expansion tank 12.51
Name Monique Lum
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13225 SW Village Glenn Circle Garbage disposal 1 25.02 25.02
City/State/ZIP:Tigard, OR 97223 Hose bib 25.02
Phone ( 503) 860 21$Q Fax:( ) Ice maker 12.51
a'sra ��-
gn .,_ 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 4 25.02 100.08
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
- - -` Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal I}Q, j),
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) 'g,0 I
Authorized signature: TOTAL PERMIT FEE , " 16Y.13
Print name; Date: This permit application expires if a permit is not obtained within 180 days
Monique Lum 12.29.2020 after it has been accepted as complete.
°Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permils\PLMU-PermitApp.dot 10/01/09 440-46161(10/02/COM/WEB)
A
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty Fee(ea) Total Square Footage: a.
Footing drain-1"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' 30 62.54 • Alpedical Gas Systems:
Wuter Service each additional 100 37.52 valuation Permit Fee.
Storm&Rain Drain- I st 100' 62.54 $L00 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(ca) '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 90.001hr 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 Retorate
Baptistry/Font El Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacu7�i/whirlpool engineer.
ElCar Wash Each Stall New exterior plumbing site utilities for any complex structure
Drive Thu as defined in OAR918-780-0040.
W ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: -Commercial al ❑ 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
0 Isometric or riser diagram is required for new buildings
-Car warn 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: -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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
L\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2