Permit (7) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00326
Date Issued: 8/25/2022
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S111 DA22700
Jurisdiction: Tigard
Site address: 15505 SW APPLEWOOD LN
Project: Mascarro Subdivision: HERITAGE CROSSING Lot: 46
Project Description: Replacing fixtures after fire damage. (1)shower pan,(1)garbage disposal.
Contractor: I M PLUMBING Owner: MASCORRO, SHERYL TRUST
PO BOX 90 6369 SE KETCHUM ST
WASHOUGAL,WA 98671 MILWAUKIE, OR 97267
PHONE: 503-209-9032 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Garbage Disposal 08/25/2022 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 08/25/2022 $12.51
1 12%State Surcharge- 08/25/2022 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 35 ea Minimum Fee Adjustment- 08/25/2022 $34.97
Type of Const: Plumbing
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 t e rules
Issued By: } Permittee Signature: —""''�
J '�14
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
City of Tigard Received
Date/B : Permit No.: CVL ,
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Ocher Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: Jura* ®See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
;. Nsm
❑Demolition Forspecial in ormalion use checklist
❑New construction Descri tion Ea. Total
Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
❑ I-and 2-family dwelling ❑Commercial/industrial
SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
Site utilities:
NMI D Q A/� Catch basin or area drain 18.76
Job site address: rj O (,(/ f}P?t IN O
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 6 A-R- Q Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
I alum IPA
Clothes washer 25.02
tr l./ar G CO)v C Y A Dishwasher 25.02
R 2� Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
M C Fixture/sewer cap 25.02
Name: pte,/-
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( )
Ice maker 12.51
Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: T , Y'- L„V ^-t� 1 N6 12.51
Primer
Contact name: O /N� M k,-\ �` V Roof drain(commercial) 12.51
Address: p yj O)C O Sink/basin/lavatory 25.02
City/State/ZIP: %.,J k 5 k-1 0 v 6 L • t� T 1 Solar units(potable water) 62.54
Phone:( 15 o 2 b j _ tjo3 Z Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
wx, r. rY - Water heater 37.52
Business name: /1 L V I N6 Water piping/DWV 56.29
Address: i! OK O Other: 25.02
City/State/ZIP: t y 14 O 0 6 Ar L �..� A'� � '$ � �'1 Subtotal
Phone:(TO Fax:
L b - 1 0 3 �• Minimum permit fee: $72.50
( )
Plan review (25%of permit fee)
CCB Lic.: 5 Z Z Plumbing Lic.no.: -3 ( State surcharge(12%of permit fee)
Authorized si re: TOTAL PERMIT FEE !�
Date: {4 v Z� ' This permit application expires if a permit is not obtained within 180 days
Print name: Z after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
l:\Building\Permits\PLMU•PerniiiApp.doc 10/01/09 4404616T(10/02/C0M(WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Footing drain-1"10050.03 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-1 st 100' 62.54 7 201 and eater $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-1 st 100' 62.54 7slO,0
000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 o$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 790.00/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*.
Mm
y r66g tem, e Plan review is required for any of the following.
Fizture �re4or, F + * ePtice/' Please check all that apply.
worR'Pec o'iltned., Cap ed' A 12elocate.
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirl Dol
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water idor/Water As irator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial [:] Any multipurpose fire sprinkler system.
❑ Any complex structure as defined in OAR918-780-0040.
Domestic
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: 2"
3"
4" 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./Reffi .Drains Comments regarding fixture work:
Oil Separator Cas Station
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/lJtil 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:
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