Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00519
Date Issued: 12/29/2021
T iC' RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S1046CO2200
Jurisdiction: Tigard
Site address: 14040 SW FERN ST
Project: Bourquin Subdivision: HANDY ACRES Lot: 22
Project Description: (1)new sink to powder room,(1)bar sink to kitchen,and adding new plumbing fixtures to master bathroom.
Contractor: ROME PLUMBING INC Owner: MOHAMMAD BASHIR
17295 SW EDY RD 13534 SW LINDEN DRIVE
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-625-1452 PHONE: 503-267-9087
FAX: 503-625-1452
FEES
Quantity Description Date Amount
1 ea Garbage Disposal 12/28/2021 $25.02
Specifics: 1 ea Ice Maker 12/28/2021 $12.51
3 ea Sink 12/28/2021 $75.06
Type of Use: SF 1 ea Tub/Shower/Shower Pan 12/28/2021 $12.51
Class of Work: ALT 1 ea Water Closet 12/28/2021 $25.02
Type of Const: 1 ea Water Heater 12/28/2021 $37.52
Occupancy Grp: 1 12%State Surcharge- 12/28/2021 $22.52
Stories: Plumbing
Total $210.16
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.
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Building Fixtures CEIV
SECReceived
U 13125 SW Hall Blvd.,Tigard,OR 97223 . 0 9 z ,. Permit No.:
Datc/By: /rc"/
111
Phone: 503.718.2439 Fax: 503.598.196Dd�OF��� Plan Review / lip
r � "�('t + /}(
City of Tigard
T1GARD Inspection Line: 503.639.4175 'I Date/By: OtherPcnnitNo.:mSTror m-OUZ�Z
_ Internet: wKnv.tigard-ocgov �UILQ({1f( ` Date Ready/By: m-�ri::-� S See Page 2 fur
Notiticd/Mcthad: f a"d.i Supplemeantallnforntation
TYPE OF WORK " `'` FEE* SCHEDULE
0 New construction -
0 Demolition For special Information use checklist.
Addition/alteration/replacementDescription Qty. f Ea. J Total
0 Other: New 1-2-famlly dwellings(includes 100 ft.for each utility connection)
• CATEGORY OF CONSTRUCTION SFR(I)bath 1
+ 312.70
I-and 2-family dwelling ❑CommerciaUindustrial SFR(2)bath 437.78
❑Accessory budding SFR(3)bath 500.32
0
Multi-family
❑Master builder - Each additional bath/kitchen 25.02
0 Other:
• JOB SITE INFORMATION'AND LOCATION Fire utisprlities:
( sq.ft.) Page 2
Site uNllties:
Job site address: 40 t.,6"7-.erw St. Catch basin or area drain 18.76 -City/State/ZIP: &„�_/ O2 /1 7 z�3 Drywell,leach line,or trench drain 18.76
Suite/bldg.lapt.no.: C� ,`7Q^ -i Footing drain(no.linear ft.: ) Page 2
Project name: k.e tk I M od „Q
Cross street/directions to job site: �C� Manufactured home utilities 50.03
(Y 1 ` Manholes 18.76
* C"�'"+�.t e�S1 ��un L�� _ Rain drain connector _ 18.76
Ave_)(Ai pat- DY\ Fir LA co '4Q'+D Sanitary sewer(no.linear ft.: Page 2
b CIVe 14)CLI _ ` 0 Y1 Sd s I�e/ Sri+ Storm sewer(no.linear ft.: ) Page 2
Subdivision: ��J �� ) t n �e Water service(no.linear ft.: ) page 2
(� Lot no.: .ZZ Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF=WORK Backwater valve 12.51
J
Clothes washer 25.02
A In c Y1�Q -ec-od -L i,L1�rk VIP St f1K Dishwasher
J 25.02
}. U tN cte'- Te��, ) 0, k cif ,S'r\1,-to Vt-klae to Drinking fountain• 25.02
11 t5 7 . () -C.X)2, 3 Ejectors/sump 25.02
EK:PROPERTY OWNER 10 TENANT r.', Expansion tank 12.51
Name)4al--f-1)a ,41t G 2 a?as/ 1 r Fixture/sewer cap 25.02
Address: 1353� cd trl r_ Floor d o sink/hub
Sc )"\j 25.02
ry 7- _/ 0 9 72-Z 3 Garbage disposal _ ' Z S, 02
City/State/ZIP: 1 `[ 25.02
Phone:( ) _ Hose bib 25.02
5c3 2(0 96 Fax: I 12.51 (2,St
5. ( ) Ice maker
t: t APPLICANT trap 25.02
'` � CONTACT,PERSON' Interceptor/grease
Business name: Medical gas(value:S ) Page 2
Contact nae:A t' "6"ash't Primer 12.51
m
I y1J \ \�Y Roof drain(commercial) 12.51
Address: to J `C)Jl
Sink/basin/lavatory 3 25.02 15,O b
City/State/ZIP: N I qp-rd Da 9 7 22--3 Solar units(potable water) 62.54
Phone:(503 _bi 9 a' Fax::( ) Tub/shower/shower pan I 12.51
iz.s(
E-mail:"a„r• t.et? , 1Q-a.s h•t eg*t'a a ` . €.a M Urinal 25.02
ir'� CONTRACTOR Water closet 25.02 zr.02
Business name: :�I Water heater t 37.52 5�
Yam+ !>h. OtL. _ Water piping/DWV 56.29
Address: j -)i '5s- •
• Other: _ 25.02
City/State/ZIP: � � �. ��
•, w Subtotal 1 g1,1/4-
Phone:(�j(j�) /',0A5 _ r`, 5 Fax:( ) Minimum permit fee: $72.50 _
CCB Lic.: JetG3.tti 6 Plumbing Lic.no.: 5 y A5 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 1-2-52
Authorized signature ,.... G�
e /
TOTAL PERMIT FEE 2 Q1-1-
Print name: jrt1�1a }` ci Z Cht c Date:11`g)L02' This permit application expires If a permit Is not obtained MM.('t
st
t J`J `�' Js`� t after it has been accepted as complete. 1
"Fee methodology set by Tri-County Building Industry Se ice Bop
1.\Buihiing\Permits\PLMU•PermiApp.duc 10/01N9 440-0616T(10/O2/CUMNJEB)
i-
1:
7 lurrIbin:? Permit Application - City of Tigard
page 2-Supplemental Information
Fee Schedule: Residential Fire Su ression S stems:
Site Utilities Qty. Fee(ea) Total S uare Foots e: Permit Fee:
0 to 2,000 S 121.90
Footing drain-I°100' 50.03 $169.69
Z,(0 to 3,600
Footing drain-cach additional 100' 37.52 3,601 to 7,200 5233.20
Sewer-Ist 100'
62.54 7,201 and realer S327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54Medical Gas S stems:
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 100' 37.52 $5,001.00 to S 10,000.00 $72.50 for the first 0 and$1.52 for
each additionalS 100.00 or0fract on thereof,to
Other Inspections or Fees
Qty. Fee(ea) Total and includin S10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 S 148.50 for the first$10,000.00 and$1.54 for
I' each additional$100.00 or fraction thereof to
which no fcc is specifically indicated 90.00/hr '1�,� and includin $25,000.00.
(minimum charge-1/2 hour)
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 each additional$100.00 or0friondthereof�o
hours(minimum charge-2 hours) 90.00/hr and includin $50 000.00.
Reinspection Fees $50,001.00 and up S742.00 for the first S50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr each additional S 100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 Replied Please check all that apply.
Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool - ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3., • Isometric or Riser Diagram
❑ 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 Comments regarding fixture work:
Ice MachiRefrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
SwimmingC Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Water Exr- tractor fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal '
v Other Fixtures:
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