Permit Support Document CITY OF TIGARD PLUMBING PERMIT
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' COMMUNITY DEVELOPMENT Permit#: PLM2022-00160
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 '
Date Issued: 5/2/2022
Parcel: 1S125DB04800
Jurisdiction: Tigard
Site address: 7185 SW SHADY CT
Project: Lawrence Subdivision: SHADY DELL NO.2 Lot: 22
Project Description: Plumbing for relocating the kitchen and 50 sq.ft.addition: (1)dishwasher, (1)garbage disposal, (1)hose bib, (1)
ice maker,and(1)sink.
Contractor: DELTA PLUMBING INC Owner: LAWRENCE, BRIAN J REVOCABLE TRUST
12205 SE 108TH AVE 7185 SW SHADY CT
HAPPY VALLEY, OR 97086 PORTLAND, OR 97223
PHONE: 503-998-0683 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 05/02/2022 $25.02
Specifics: 1 ea Garbage Disposal 05/02/2022 $25.02
1 ea Hose Bib 05/02/2022 $25.02
Type of Use: SF 1 ea Ice Maker 05/02/2022 $12.51
Class of Work: ALT 1 ea Sink 05/02/2022 $25.02
Type of Const: 1 12%State Surcharge- 05/02/2022 $13.51
Occupancy Grp: Plumbing
Stories:
Total $126.10
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 ob 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
Building Fixtures FOR OFFICE I/SE ONLY
City of Tigard Received
. •J ll / Permit No..
13125 SW Hall Blvd.,Tigard,OR 97223 DateiBy: S1e2" �,.- � 1,zp7 a.-ar i�
Plan Review
Phone: 503.718.2439 Fax: SU3.59 r���EDOther Permit No.�S r�t 30
t,J 5 Date/By: !� %LAI
1 I L i,1 I;p Inspection Line: 503.639.4175 Date Ready/By: Rork: IZI See Page 2 for
Internet: www.tigard-or.gov �� Notified/Method: "�'e Supplemental Information
TYPE OF WORK W FEE* SCHEDULE
For special in ntauon use checklist
❑New construction a I or
uit P 1
DING DIVISIOt Description Qty. Ea. l Total
n Addition/alteration/replacement New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
n I-and 2-family dwelling ' El Commercial%industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building j ❑Multi-family
1 Each additional bath/kitchen 25.02
0 Master builder ! 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 7185 SW Shady Ct. Catch basin or area drain 18.76
City/State/ZIP: Portland, OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Additon Lawrence 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.:it Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Tax I D.R231 305 Lot no.: Fixture or item:
Tax map/parcel no.: 1 S 1 25B04800 Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Adding 50 sq ft and repositioning the kitchen Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name:
Brian Lawrence Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 7185 SW Shady Ct Garbage disposal 1 23.02
City/State/ZIP: Portland OR 97223 Hose bib 1 25.02 "S5.42
Phone:( 5033098868 Fax:( ) Ice maker 1 12.51
i //�S/
nil APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Ryone LLC Medical gas(value:S ) Page 2
Primer 12.51
Contact name: Raul O n e s c u
Roof drain(commercial) 12.51
' Address: 5321 Lakeview Blvd. Sink/basin/lavatory 1 25.02 a)._
City/State/ZIP: Lake Oswego OR 97035 Solar units(potable water) 62.54
Phone:( ) 9713229416 Fax: :( ) Tub/shower/shower pan 12.51
F-ma;l:
raulone28@gmail.com Urinal 25.02
CONTRACTOR Water closet 25.02
- Water heater 37.52
Business name: Delta Plumbing, Inc. Waterpiping/DWV 56.29
Address: 12205 SE 108th Ave Other: 25.02
City'State/ZIP: Happy valley, OR 97086-5849 Subtotal lti,t 5`0)
Phone:( )5039980683 Fax:( ) Minimum permit fee: S72.50
182846Plumbing PB562 Plan review (25%of permit fee)
CCB Lie.: Lie.no.:
State surcharge(12%of permit fee) /�. -1
Authorized signature: A. TOTAL PERMIT FEET/ ,O
Print name: Raul *'r scu Date: 4/29/2022 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.\Building:PrnnitsU'L.MLI-Perma.App.doc 10%01/09 440-4616T(I(Cti2/CUM/WEB)
'Plumbing Permit Application - City of Tigard
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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 S 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' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storni&Rain Drain-let 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$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 90.00ihr and including$50,000.00.
Additional plan review the 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
❑ Any new commercial building with water service 2"and
Baptisny/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor 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.
Thinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
isometric or Riser Diagram
0 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
Ice Mach./Rcfrig.Drains Comments regarding fixture work:
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
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:
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