Permit CITY OF TIGARD PLUMBING PERMIT
11111 COMMUNITY DEVELOPMENT
Permit#: PLM2021-00360
Date Issued: 8/26/2021
T g G A R h 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AD90075
Jurisdiction: Tigard
Site address: 14992 SW 109TH AVE
Project: White Subdivision: CANTERBURY WOODS CONDO Lot: 75
Project Description: Relocate bathroom fixtures for remodel.
Contractor: MISTER E'S CONSTRUCTION Owner: WHITE, CYNTHIA R
PO BOX 4116 5215 N YALE ST
HILLSBORO, OR 97123 PORTLAND, OR 97203
PHONE: 503-680-6355 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 08/26/2021 $25.02
Specifics: 2 ea Tub/Shower/Shower Pan 08/26/2021 $25.02
ea Water Closet 08/26/2021 $25.02
Type of Use: 1 12%State Surcharge- 08/26/2021 $9.01
Class of Work: Plumbing
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
Issued By: 6 tv- / Permlttee Signature: p�� -741
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
Building Fixtures RECEIVED FOR 01 l'ICE USE ONI.1
AUG 2 Z Received Z�/2, Wit ' t)M Z021 e9036, 0
City of Tigard rj ��� Received
Permit.'
11111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
U ' Phase: 503.718.2439 Fax: 503.598.}9(>gv OF TIGARD DateBy Other Permit No
Inspection Line: 503.639.4175
IlGAR15 BUILDING DIVISION Date Ready By ty /ice �d Ions 51 See Page 2 for
Internet: www.ugard-Ix.gov Nottied.Met.d / Supplemental Information
TYPE OF WORK t 1444-6: A/ / FEE* SCHEDULE
For special information use checklist.
❑New construction 0 Demolition
Description I Qty. i Ea. I Total
(q Addition'alteration replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
0 1-and 2-family dwelling 74b1 Commerciabindu slit al SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.Il.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14992 SW 109th Ave Catch basin or area drain 18.76
Drywell.leach line,or trench diain 18.76
City/State-LIP: Tigard, OR. 97224 Foohng dram(rio.linear ft.: ) Page 2
Suit Id pt.no.: 9 Project name:?yeCi6t(On kr�di( CSS Manulhctured home utilities 50.03
Cross streeVdirections to job site: Manholes 18.76
Canterbury Lane Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear 11.: ) Page 2
'Water service(no.linear 11 ) Page 2
Subdivision: I Lot no.: 8800 Fixture or item:
Tax map.parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
�w- g Clothes washer 25.02
bias C_ 7TJ•Gfi'Osier'r� r JVI V(, Sink 7 4d/ .V&J 1147'^'ei--- Dishwasher 25.02
.Rr•-G{ /WOVC TL A 1 Ci?5S i-BbM • Drinking fountain 25.02
Ejectors-sump 25.02
IA, PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Cynthia White Fixturrsewercap 25.02
Floor drain'floor sinlehub 25.02
Address: 5215 N Yale St
Garbage disposal 25.02
City'State'ZJP: Portland, OR. 97203 Hose bib 25.02
Phone:(503)351-1736 Fax ( ) Ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON Interccptorigreasctrap 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 Stute✓ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub'showerishower pan oZ 12.51
E-mail: Urinal 25.02
Water closet / 25.02
CONTTRACCOR
' Water herder ';?57
Business name: s,,,,,,,,,,, ,,„„., ,,,,,,A, ri�C Water piping'DWV 56.29
Address: POI 6cx yilo Other: 25.02
Subtotal City/State/ZlP: /Lri.LS4..a a, 9,7/?-3 ____ __
Minimum permit fee: $72.50
Phone:(.5 ) yo - b3-5 5 Fax:( ) Plan review (25°-oofpermit fee)
CCB Lic.: ` 44 927 Plumbing Lic.no.:IV• 'j0,1-3 P
State surcharge(12%of permit fee)
Authorized signature: rya �4 e TOTAL.PERMIT FEE r,/r 07
/ T Date: TZ This permit application expires if a permit is not obtained within 180 days
Print name: i��//gef. 4. jr..5�'/✓ I°!5 0 ^) after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board
I^.MnfdnnBemnlriPI.MI t-Pemil Alai doe 10,0I/CIt J40-4616T(It'll?/ 1M.14TRY
Water Meter Fixture Unit Worksheet for Additions/Remodel
IVED
Please complete the following inform etion: f QUG 2 5 2021
t�l 1}� 11 Q. W I„ I - c:ITY O TIGARD
Customer Name: r►'I `t T BUILDING DI�ISI�N
Service Address: Street/Suite #: 1 44 qq 2. 'J\a\I 1 G Q T"}-; Ave.
City: i I q GLird State: 02 Zip: ��12-24
Phone Number: 5077 51 � \121(p Email: a 11 d 1 w (P a1S 1(?fV t 1rSt•L-Ow,
Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add.
Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at
total. the proposed total.
Fixture Unit Current Point Current Proposed Point Proposed
Quantity Value Total Addition Value Total
Bar sink x 1 = x 1 =
Bidet x I = x 1 =
Clothes washer 1 x 4 = LI x 4 =
Dishwasher 1 x 1.5 = t , rj x 1.5 =
1s1 Outside Water Spigot x 2.5 = x 2.5 =
Water Spigot,each add'I x 1 = x I =
Kitchen sink 1 x 1.5 = 1 , 5 x 1.5 =
Laundry sink x 1.5 = x 1.5 =
Lavatory(bathroom sink) 2_ x I = 2 x I =
Water closet, 1.6 GPF(toilet) I X 2.5 = 2 ,5 x 2.5 =
Bathtub/whirlpool x 4 = I x 4 = L4
Shower stall x 2 = t x 2 = i2.
Bath/shower combo i x 4 = 4 — % x 4 = - 4
Current Points: 1 , . 5 Proposed Increase: 2—
Current Points +Proposed Increase= 11. ! =New Total Points =Required Meter Size
Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=%" 37.5 and over points= I"
New Meter Size Needed for New Total Points: Cost: $ (see page 1)
Current Meter Size per Utility Billing: Cost: $ (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
FOR OFFICE USE ONLY
Current Meter Size Confirmed with UB
Signature of UB Representative Date
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