Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00236
Date Issued: 7/6/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S1116A13600
Jurisdiction: Tigard
Site address: 9744 SW VIEW TER
Project: MITCHELL Subdivision: ADAMAMY TERRACE Lot: 6
Project Description: Plumbing for addition previously located at 14405 SW 97th Avenue:(1)dishwasher, (1)hose bib,(3)sinks, (2)
tub/showers,(1)water closet,(1)water heater,and(1)bidet. WATER METER UPSIZE REQUIRED PRIOR TO
FINAL INSPECTION.
Contractor: OWNER Owner: MITCHELL, PATRICIA& MICHAEL
9744 SW VIEW TER
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 07/06/2022 $25.02
Specifics: 1 ea Hose Bib 07/06/2022 $25.02
3 ea Sink 07/06/2022 $75.06
Type of Use: SF 2 ea Tub/Shower/Shower Pan 07/06/2022 $25.02
Class of Work: ADD 1 ea Water Closet 07/06/2022 $25.02
Type of Const: 1 ea Water Heater 07/06/2022 $37.52
Occupancy Grp: 25 Misc Other Fee 07/06/2022 $25.02
Stories: 1 12%State Surcharge- 07/06/2022 $28.52
Plumbing
Total $266.20
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 m obtain a copy o he rules
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available i pection 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 RECEIVE FOR OFFICE- USE ONL1
Cityof Tigard and G��d •eceived
ll � A l 2 9 // Permit No.: 2
• 13125 SW Hall Blvd.,Tigard,OR 97223 1 V 2022 Date/By: / / '- / i ,�/{�-�j y�436
Plan Review / {�1 - tr v W
Phone: 503.718.2439 Fax: 503.598.19 0 - Other Permit Not
.I1 YDate/By: v1g Lf T
Inspection Line: 503.639.4175 ��TIGARD Date Read
y/By:Internet: www.tigard-or.gov �.�l-,ni<!I-. rlr,,:e-t, Juris: See Page 2for
Notified/Method: ANO Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath
❑ 1-and 2-family dwelling IDCommercial/industrial SFR(2)bath 437.78
CI Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION ND LOCA 'I Site utilities:
Job site address: L�l� S� ,e 4 Catch basin or area drain 18.76
C Drywell,leach line,or trench drain 18.76
City/State/ZIP: / ,� . p 04 v_z-z ,,t- Footing drain(no.linear ft.: ) Page 2
rGSuite/bldg./apt.no.: Project name: Aile D9"// �/ 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.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
��f// _ (/M4L1( /�Qy� q,( �f Clothes washer 25.02
!V �1.1/i `�t�y'"I �// Dishwasher 25.02 OS *ex
Drinking fountain 25.02
Ejectors/sump 25.02
OPERTY OWNER ❑ TENANT Expansion tank 12.51
//s Fixture/sewer ca 25.02
Name: /� �� �c�� Floor drain/floor sink/hub 25.02
Address: ?177
.*g Su) Vell ir'e- (,(-,4z.1-z._, Garbage disposal 25.02
City/State/ZIP: (6.11_ P c � Hose bib • 25.02 ;6 :l_
Phone: 1 i Fax:( ) / / Ice maker 12.51 4f
/ 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: SZf/"x� A � �lZ g
' Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 3 5'
25.02 7
City/State/ZIP: Solar units(potable water) 4 b�
Phone:( ) Fax: :( ) Tub/shower/shower pan ' 12.51 Va
E-mail: Urinal ii( 25.02
Water closet 5.0
CONTRACTOR Water heater i 37.52
Business name: C%�'C,/"-r-/- Water Pm�iP DWV 56.29
Address: Other: oQy,..{-i1- / 25.02 ,�.
City/State/ZIP: ("A J Subtotal 237,Gyt""
Phone:( ) F ( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: robin Lic.
State surcharge(12%of permit fee) , r
Authorized signature. 1/1•77
TOTAL PERMIT FE
Print name:N( _(f C f.lr�l "2Z. This permit application expires if a permit is not obtained vn180 days
t /lam v Date:
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
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-1"100' 50.03 0 to 2,000 $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:
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$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
p 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
❑ 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
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 0 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
4" 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./Refrig.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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs
Please complete the following information:
Customer Name: xy/`lf,✓ ,. ./ `"' (i1 %)- Y . "`
Service Address: Street/Suite#: } � -5 -- t. i �!t' . --
`" 7 State: Zt
Citv` � .,.n..�
Phone Number: Email: d C° e. ( 4)K. (It"!
(
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 = 0 — a. x 1 Via,,....:'_
* 9
Bidet x 1 =_ t7 ,� x 1 " ...__,
Clothes washer mm ' x 4 — if 4 =
Dishwasher x 1.5 = f Sr _ x 1.5 = t,,5
1"Outside Water Spigot , f,'` x 2.5 = j,. x 2.5 _ `a
Water Spigot,each add'l 1/' x 1 /` x 1 —
Kitchen sink ix 1.5 = f x 1.5 —
Laundry sink x 1.5 = x 1.5 =
Lavatory(bathroom sink) x 1 = ( x 1 = /
Water closet,1.6 GPF(toilet) . x 2.5 = ' _w , mt x 2.5 = )_J
Bathtub/whirlpool x 4 = x 4
Shower stall ._ x 2 = 9,. y ' x 2 —
Bath/shower combo x 4 = x 4 =
Current Points: Proposed Increase: j,'
Current Points+Proposed Increase= _ i le•5 —New Total Points —Required Meter Size I,
Meter Sizes: 1 to 30 points =5/8" 30.5 to 37 points=3/4 37.5 and over points= 1"
New Meter Size Needed for New Total Points: Cost: $X X X 094 09see page 1)
Current Meter Size per Utility Billing: '' Cost: $ • (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $ X'CXXECXX� $4,836.00
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
FOR OFFICE USE ONLY Meter size needs to increase to 3/4 inch. Costs have been
updated.
Current Meter Size Confirmed with UB W J. Bentley 07/06/2022
Signature of UB Representative Date
1:/Building/Forms/WaterMeters_070121 Add.docx Page 2
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Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
ftvwc. 47 r
P t Name of Permit Applicant c� y\ 'gnature of Permit Applic Date
Permit#: /7t 2-AV---Gbea6
Address: q Wei f..J U\P(.4) It '
Issued by: a./ • Date: 7/6//..1
This Copy for Permit Offices