Permit y CITY OF TIGARD PLUMBING PERMIT
44
COMMUNITY DEVELOPMENT Permit#: PLM2021-00369
Date Issued: 8/31/2021
T fGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AD90020
Jurisdiction: Tigard
Site address: 14866 SW 109TH AVE
Project: Johnson Subdivision: CANTERBURY WOODS CONDO Lot: 20
Project Description: Replace shower pan.
Contractor: MLP PLUMBING COMPANY Owner: JOHNSON, JODI L
4505 SW 194TH CT 14866 SW 109TH AVE
ALOHA, OR 97007 PORTLAND, OR 97224
PHONE: 503-686-4915 PHONE:
FAX: 503-641-2407
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 08/31/2021 $12.51
Specifics: 1 12%State Surcharge- 08/31/2021 $8.70
Plumbing
Type of Use: MF 60 ea Minimum Fee Adjustment- 08/31/2021 $59.99
Class of Work: ALT 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
Issued By: �A/Y-k-a7GT , i Permittee Signature: 2 L/e/- ' " 0/. /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 Application
t
Building Fixtures NEC�EI V FOR OFFICE USE ONLY
City of Tigard - AUG 06 2021 Received: 7,,..,
t ./ e)" Permit Nc�s`, 7 -de3 f 7
13125 SW Hall Blvd.,'Tigard,OR 97223 Date/By:rB df
Phone: 503.718.2439 Fax: 503.598.1Plan Review
° `�Q-[1(OF TIGARD Other Permit No..
-
TIGARD Inspection line: 503.639A 175 ?IJILDINCa t'lt'/I (f'!f�l Date Rcady/By: ,<'e luris El See Page 2 for
Internet: w'ww.tigard-or.goy tv Notificd'Alethod /�'.' Supplemental Information _
TYPE OF WORK 67 ii1M-. , i /1/ FEE* SCHEDULE
❑New construction 0 Demolition For special in ormarion use checklist. _
Description Total
1 dditionialteration/replacement 0 Other: New I-2-family dwellings(includes 100 It.for each utility connection)_
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
0 1-and 2-family dwelling 0 C'onumcrcial.'industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building Ei)Nlulti-lamily Each additional bath/kitchen 25.02
❑Master builder 0 other: Fire sprinkler( sq.fL) Page 2
JOB SITE INFORMATION AND
LOCATION Site utilities:
address:Job site 14 J. „_L 1 D"1`7 •i Catch basin or area drain 18.76
ss�= Drywell,leach line,or trench drain 18.76
C'it,/State/Zll r7
y � l't , �� �� !i Footing drain(no.linear R.: ) Page 2
Suite/bldg./apt.no.: Li Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
etfrikibid,///'
�0OCJ�� „/,.,SRain drain connector 18.76
J t (.� Sanitary sewer(no.linear 11.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear IL: ) Page 2
Subdivision: I,ot no.: Fixture or item:
"fat map/parcel no.: Back flow preventer 31.27
DESCRIPTION OF WORKBackwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain ' 25.02
Ejectors/sump 25.02
PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: d l b� �D� Fixture/sewer cap 25.02
' ` 0° `� Floor geadisposa sink/hub 25.02
Address: A 1 `i►f Garbage disposal 25.02
City/State/ZIP: 4-1-i / 4 d 07.--- 601.--04 Hose bib 25.02
Phone:(5 p1j • %'r • d22^' Fax:( )no„ Ice maker 12.51
VI APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business nattier- t 4 an RCAY'S Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Root'drain(commercial) 12.51
_
Address: ( '7i 0 r.1 Lit 'TO/J A E. Sink/basin/lavatory 25.02
City/State/ZIP; let 1-7 2 o3 Solar units(potable water) 62.54
Phone:( I'ublshow /§tower pan 1 12.51 1/.1,�jt
�5 �Li I Fax::( • t '�31'ID __ ••
1 Urinal 25.02
F-mail:301A.M.k &:' U b t t otr• Conn 25.02
Water closet
CONTRACTOR
I Water heater 37.52
Itusiness name: , Al l t� PL i.(,l-1 g t NIe-"Water piping/DWY 56.29
Address: I-1 S D S.l ) 1 q it--�� Cr _Other: 25.02
City/State/ZIP: p " .4.. p )2- . 97a 7 F - Subtotal ( 31
1 Minimum permit few: $72.50
1'i)nnc.( ) Pax'( )
Plan review (25%ofpermit fee) J ./Z,
67(.'Cli
Lie.: .: ,1,2. 40 y V Plumbing Lie.no.: p/�4, i State surcharge(12%of permit fot) $ �b a
Authorized si *nth � TOTAL.PERMIT FEE r
rThis permit application expires if a permit is not obtained within tt class
Print ran Dale:40D/ 9/ after it has been accepted us complete.
f "Fee methodology set by Tri-County Building Industry Service[Mari
ttAmid``ineennBs',PLMU-PmnmAppdoe IW01,5 4+10-4616T(IO!O2JCt)MJWEB)
1
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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 $1 69.69
3.601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 1(HI' 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 $1.00 to$5,000.00 Minimum fee S72.50
Storm&Rain Drain-each additional 100' 3752 $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(``a) "Total each additional$100.00 or fraction thereof,to
A 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:
Arc 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 flan review is required Isor any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
f3aptistr`'Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jactrrr..i/Wh irlpool
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
-Driveach "Theft as defined in OAR918-780-0040.
Cuspidor/Water Aspiator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye WashSubmit 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 Wash[rain
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Maeh./Refrig.Drains Co ments rept rding fixture work:
Oil Separator(Gas Station).' r 111)4- rep)i YID`or .
Rec.Vehicle Dump Station vvvv �� �J
Shower: San' !'/�Ti'ta �I� � i/ A L
alSink: -tav/Bar non-food related � P � I-Bradley j�3 /�
444
-Com/Serv/(Jtil food related Pixel
-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:U3uilding\Permits\PLMF PermitApp.doc 08/04/2011 2