Permit CITY OF TIGARD PLUMBING PERMIT
. ' COMMUNITY DEVELOPMENT Permit#: PLM2021-00470
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/10/2021
Parcel: 2S 104BA07200
Jurisdiction: Tigard
Site address: 14030 SW LIDEN DR
Project: EVANS Subdivision: CASTLE HILL NO.2 Lot: 107
Project Description: Adding a second sink to the kitchen.
Contractor: OWNER Owner: EVANS, DAVID J&ALLE M
14030 SW LIDEN DR
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 11/10/2021 $25.02
Specifics: 1 12%State Surcharge- 11/10/2021 $8.70
Plumbing
Type of Use: SF 47 ea Minimum Fee Adjustment- 11/10/2021 $47.48
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: / 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 /0 it ii-1 I3
Building Fixtures FOR OFFICE LASE oyLI
City of Tigard ' 4IVE
1t eceivea �� / /�`
Date/By: Permit No.:
11 ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Ayv, ,i ex)1170
a Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 OCT8 y qy / Other Permit No.:
U 8 LoL 6 Date/By: /� et ..,,2
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: /� aris: ® See Page 2 for
� ,�
Internet: www.tigard-or.gov .• �� , Notified/Method: // iO ) '-� Supplemental Information
TYPE OF WORK fa l ,,l.<,,t ?4 FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description Qty. Ea. Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
IS 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building El Multi-familySFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( ,sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14030 SW Liden Dr Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Evans Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
jpG„'I. 7, e,-rr1 , �,t�.� - 1L Rain drain connector 18.76
h.,_ . C tti�/ w f �/s��y/��/ )/ - 'Sanitary sewer(no.linear ft.: ) Page 2
n /f / I 419 ill'Stbrm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Castle Hill I Lot no.: 07 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Kitchen & Bathroom Cosmetic Updates. Dishwasher 25.02
Added a second sink to the kitchen Drinking fountain 25.02
Ejectors/sump 25.02
1: PROPERTY OWNER I 0 TENANT Expansion tank 12.51
cap
Fixture/sewer 25.02
Name: David Evans
Floor drain/floor sink/hub 25.02
Address: 14030 SW Liden Dr
Garbage disposal 25.02
City/State/ZIP: Tigard, OR 97223 Hose bib 25.02
Phone:(503) 488-9209 Fax:( ) Ice maker 12.51
1;1 APPLICANT Fft CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: David Evans
Roof drain(commercial) 12.51
Address: 14030 SW Liden Dr. Sink/basin/lavatory 1 25.02 Q�".6),,
City/State/ZIP: Tigard, OR 97223 Solar units(potable water) 62.54
Phone:( 503)488-9209 Fax::( ) Tub/shower/shower pan 12.51
E-mail: davidjevans4@gmail.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Owner Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal ?IAA,
Phone:( ) Fax:( ) Minimum permit fee: $72.50 -7,X.
CCB Lie.: Plumbing Lic.no.:
Plan review (25%of permit fee) '`--
,,,,,,,, E, State surcharge(12%of permit fee) D,' )
Authorized signature: David Evans 1 -
610,02,
N.„1 TOTAL PERMIT FEE <
Print name: David Evans Date: 10/28/21 This permit application expires if a permit is not obtained within 180�a s
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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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-151 100' 50.03 0 to 2,000 $121.90
Footing dram-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' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 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(ea) 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 90.00/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
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each ❑ New exterior plumbing site utilities for any complex structure
Stall as defined in OAR918-780-0040.
-DrivCuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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
❑ Isometric or riser s
diagram is required for new buildings
-Car Wash Drain g q �'
Garbage Domestic non-food that meet the qualifications above.
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: -Lay/Bar 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: