Permit CITY OF TIGARD PLUMBING PERMIT
° '!ICOMMUNITY DEVELOPMENT Permit#: PLM2022-00212
Date Issued: 6/28/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135CD03601
Jurisdiction: Tigard
Site address: 9625 SW LEWIS LN
Project: Santos Subdivision: RUTH Lot: 2
Project Description: Adding(2 lavatories,(1)shower,and(1)water closet to new master bathroom.
Contractor: SHERWOOD PLUMBING COMPANY Owner: JENNA SANTOS& MATTHEW TORESON
P.O. BOX 1398 9625 SW LEWIS LN
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-349-5429 PHONE: 808-518-0493
FAX:
FEES
Quantity Description Date Amount
2 ea Lavatories 06/28/2022 $50.04
Specifics: 1 ea Tub/Shower/Shower Pan 06/28/2022 $12.51
1 ea Water Closet 06/28/2022 $25.02
Type of Use: SF 1 12%State Surcharge- 06/28/2022 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.08
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: Per 'tee Signature: CCL' /07C0751
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 (WE1Ch; I SE 01Li
Receved /7/7)2
City of Tigard � M��"12 �2IL.
JUG 1022 Dateive Lf./_ /� +C/
11111 - • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598. IY OF TIGFtRLi Date/By: Other Permit No.:
Ti G A R D Inspection Line: 503.639.4175 r ^ n �, Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov PMILDING nIVISI0i'^ Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
gAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath r' 312.70
1-and 2-family dwelling 0 Commercial/industrial 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.ft.) I Page 2
JOB SITE INFORMATION'A' AND1 LOCATION Site utilities:
Job site address: 9(025 S L t i 1,N,/ t n Catch basin or area drain 18.76
�;��� � �}2ti�i Drywell,leach line,or trench drain 18.76
City/State/ZIP: Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 11135 Fir 3I"I I ptnnD\ohm Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
q 6 rrN I C;itun D V r9 Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
2 w.*✓ i v/L i WL )h r i�?.!Yt/
Storm sewer n..inner ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
U� Clothes washer 25.02
`Addin 1 MARK ba1-hroom wihnln Dishwasher 25.02
Vr•( •.0(t 5�1111 U2 a (AA Win OU Y Ihp,/(� • Drinking fountain 25.02
anl%., Silo W a+1`d h i( I'• Ejectors/sump 25.02
PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: donna S •�'b5 fi M-o-1-iicru •1'o1•?50 1 Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: q 625 9ou LiApi5 Lh
Garbage disposal 25.02
City/State/ZIP: li air d 1 0 1. (112l3 Hose bib 25.02
Phone:AA ) 618(8 • Q 4q$ Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 1* 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/sh er/shower pan ' 12.51
E-mail: Urinal 25.02
Water closet ` 25.02
CONTRACTOR
Water heater 37.52
Business name: ChCl w Od a P It)nib; hi ul Water piping/DWV 56.29
Address: 10 fox t 3 403 Other: 25.02
City/State/ZIP: Shy/Imo o d ` b it 1}4 4 0 Subtotal
Phone:( 3 ) 22 • 9"?.0 Fax:( ) /f 6-3 Minimumpermit fee: $72.50
CCB Lic.: 2.0 0 b , di(f( Plumbing Lic.no.:/ter/3 7/ Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:5 Carman h s Date:b ) of 1202.3
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\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
I� 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 PIumbing 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 ElAny 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 Stall 0 New exterior plumbing site utilities for any complex structure
-Driver Tani as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
ElDomestic 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
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
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: L L1-
Oil Separator(Gas Station) him bt Y ii 1 n d ' 1 S h «l S l lnq nb,�a T n'
Rec.Vehicle Dump Station w. a� ad do n a du volt 1)wio r
Shower: -Gang �( r • S b
-Stall
Sink: -Lay/Bar non-food related z vo V /1 y. _ a 1'4 GO rn
-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/RGEWEP
Please complete the following information: MAY 2 8 2022
Customer Name: S V1 In S a Y1 V.0 5 (;11`( OF T�UI�HV
:3U1L01NG DIVISION
Service Address: Street/Suite #: 610 Is silo i-. tti i 5 Lv
City: i 1 1(11(d State: 0 L Zip: r'J�-ZZ 3
Phone Number: SOS ' CI . Ok q ' Email: J yl ir(}S(5'40C L ryiai 1. 60 v`^
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 1 = x 1 =
Clothes washer 1 x 4 = 4. x 4 =
Dishwasher j x 1.5 = I . =j x 1.5 =
1st Outside Water Spigot 1 x 2.5 = 2,..< x 2.5 =
Water Spigot,each add'l 7 x 1 = z) x 1 =
Kitchen sink I x 1.5 = I. S. x 1.5 =
Laundry sink x 1.5 = x 1.5 =
Lavatory(bathroom sink) X 1 = 1 2 x I = 2...
Water closet,1.6 GPF(toilet) x 2.5 = 'J,& I x 2.5 = Z•5
Bathtub/whirlpool i x 4 = x 4 =
Shower stall x 2 = I x 2 = ,2,,
Bath/shower combo x 4 = 4- x 4 =
Current Points: '-O Proposed Increase: Co -5
F
Current Points+ Proposed Increase= it, =�( New Total Points =Required Meter Size 16
Meter Sizes: 1 to 30 points =5/8" 30.5 to 37 points='/a" 37.5 and over points= 1"
New Meter Size Needed for New Total Points: N Cost: $ (see page 1)
Current Meter Size per Utility Billing: 6 PzE, 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)
**************************************************** ******** *****************e****motred
FOR OFFICE USE ONLY I- ' 1�'�' ' -'� ZL 1�1 G 1�G�Se'
Current Meter Size Confirmed with UB - 6 j�7/cam
Si ure of UB Representative Date
t:/Building/Forms/WaterMeters_070121_Add.dOCX Page 2