Permit CITY OF TIGARD PLUMBING PERMIT
II
g ',1 COMMUNITY DEVELOPMENT
Permit#: PLM2022-00385
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/21/2022
Parcel: 2S104CD02900
Jurisdiction: Tigard
Site address: 13578 SW HILLSHIRE DR
Project: Howell Subdivision: HILLSHIRE ESTATES Lot: 29
Project Description: Plumbing for basement remodel:Adding(1)clothes washer,(1)dishwasher,(1)hose bib,(1)ice maker,(3)
sinks, (2)tub/showers, and(1)water closet.
Contractor: DOUBLE A PLUMBING Owner: HOWELL,JOHN
5017 SE 128TH AVE 13578 SW HILLSHIRE DR
PORTLAND, OR 97236 TIGARD, OR 97223
PHONE: 503-833-2764 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 09/21/2022 $25.02
Specifics: 1 ea Dishwasher 09/21/2022 $25.02
1 ea Hose Bib 09/21/2022 $25.02
Type of Use: SF 1 ea Ice Maker 09/21/2022 $12.51
Class of Work: ALT 1 ea Sink 09/21/2022 $25.02
Type of Const: 2 ea Lavatories 09/21/2022 $50.04
Occupancy Grp: 2 ea Tub/Shower/Shower Pan 09/21/2022 $25.02
Stories: 1 ea Water Closet 09/21/2022 $25.02
1 12%State Surcharge- 09/21/2022 $25.52
Plumbing
Total $238.19
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: �� Pecrrut�ignature: -Sq4) "•i"`(V
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
Site Utilities RECEIVE FOR OFFICE I ',F. ONLY
Cityof Tigard licensed
Date Hy
11111 131 SW 1lalgl 13h'd,Tigard.OR 97223 /,-j Perna Nn�!,n�/1•�y����y t`�
SEP 212022 �;,,<a H r�L 47-
■ I'Ixnle. 503 718.2470 Fax 5113.598.I')G<I other Permit NoM C�'L'�1 �v��
Inspection Lme 503 639.4173 1 arram !
1'IGARt) 2 for
Internet• %wws ti aid-or. oy' or/OF TIGARD NotriedseOv �_ Sr® Pent lla
g l? Notified Method: 6�i/ Supplemental ln(mnation
TYPE OF WOR�, niVISION FF,E' SCHEDULE
tSUIL�ING
❑New construction ❑Demolition For special information met checklist
DesenpIi n I QV. I Ea I Filial
NIII Addition/alteration/replacement 0 Other. New 1-2-family dwellings(Includes 100 It for each unlity conneclion)
CATEGORY OF CONSTRUCTION SFR(1 i bath 312 70
\{] I-and 2-family duelling • 0 Commercial/industrial St•R(2 i bath 437 78 •
❑Accesson buildingSIR(3)bath 500 32
0 Multi-family
Bach additional hath/kitchen 25.02
❑Master builder 0 Other: Ftre sprinkler( sy.It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ' )51 R S lA1- tre catch basin nr area dram 1876
�
(*well.leach line.or trench drain 18.76
Ciri/StaIrZIP: (
"dQr Fooling drain(no linear ft.: j Page 2
Suite/bldg apt.no.. J Project name 4F 2 add t dh Manul'acturesl 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 It. _) Page 2
Water service(no linear ft. _) Page 2
Subdivision. ( Lot no.: Fixture or item:
Tax map/parcel no.: Declaimspresenter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
C
1 dYlQ i/ACAtli1 i V\ 1 b4kV'r'Gs r>n Iyl � / zs.oz
r / 25.02
) t6( PF , •Shrtv.�Pf' 1 ( Dk-i rinngfountain 25.02
I JCt,IMA{4-er
❑ PROP f4.1,i11V�1S1
L -EiefPliki1ti A 1YI.l1C�d.:B.P bj1h`' Jeetars/sump 25.02
yi� ERTY OWNER TENANT Expansion tank 12.51
{,;o ` Fixture/sewer cap 25.02
Name. 1' r mil. ' t'tLL1�[
1 Floor drain/floor sinkmtih 25.02
Address:
Garbage disposal 25.02
Cil /Stale/ZIP: Hose hib i 2502
Phone ( ) Fax:( ) Ice maker 1 IZSI
`W APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:5_1 Page'_
Business name uble. urKb;ng
tinnier 12.51
Contact name. I/t,C�f( i n) Roof drum(commercial) 12.51
Address: go 1 1 S a••r ' .4V Sutk/bassrs ratory x3 25.02
City/State/ZIP'. Nb Vti4.y icl I AO_ cl1l3 LP Solar units(potable water) 62.54
Phone 632)1 lal -I e It .1 Fax::( ) '['ub/siaiwer/shoo et inn 1 12.51
E-mail'fY4V1 Sarno akoo• CQ\ al Wed 25 02
C RACTOR Water closet 1 25.02
+ ' �a ` Water heater 37.52
Business name', b try(5 A y/I i lM bin.� 1 I .C Water 1 in' )WY 56.29
''r+ 1 " W e t r r to
Address: Other: 25 02
City/StateJZIP: Subtotal
M
Phone( ) Fax;( ) uunaaii'remit fee: 572.50
CCB Lie..261 v I Plumbing Lie.no.:�P Plus mricsv (25%of permit feet
v State surcharge(12%of penult fee) }) s 51
Authorized signature: P,R1?CJ(r rt ITAt.tT.RMrr Fl: •]I��r yL 1i
Print namt" G'{3 C`Sl/fag,/
a'"Q DatC:g 10 t Z2 This permit application rapine if a permit is not obtained w hin Yea days
1 after It has Wen accepted as complete,
Jr• e aielladalo s set IA'flit-l.'uunly ltudd6la Industry lien KC Bawd
I riaiianytnmm•MMI-14raa App den IU III:09 ssa-a616a(la'ULrtH.4wEit)
Ir
cii 0.
Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs
Please complete the following information:
Customer Name: ' tF>E) 1 J6f=u.--
Service Address: Street/Suite#: / 359 Si 54-0 _i-j I t.-L..5/4 / R.t,. O(i'_
City: R,z:rt49-r.42 State: {5r7 Zip: q?Z Z- '
K...
Phone Number: Email:
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 Tonal Addition Value Total
Bar sink fa x 1 = 1 1 x I = t
Bidet x 1 = x 1 =
Clothes washer I x 4 = — / x 4 = k
Dishwasher 4 x 1.5 = II( f x 1.5 - /.S'
1"Outside Water Spigot t x 2.5 = 1,6 x 2.5 =
Water Spigot,each add'l a,...1., x 1 = `.- ( x 1 =
Kitchen sink x 1.5 = ,( x 1.5 -
Laundry sink I x 1.5 = l,y�' x 1.5 =
-- . ,_ 2.
Lavatory(bathroom so*) _ 6- _x 1 � _ )., x I =
Water closet,1.6 GPF(toi(M) it — x 2.5 = I U _. 1 x 2.5 = .
Bathtub/whirlpool _t_ x 4 = LiI x 4 = Li
Shower stall / x 2 = rl- if x 21i
Bath/shower combo S. x 4 = x 4 =
Current Points: 4,..3 Proposed Increase: 5 t 6 -5--; I
1"
Current Points+Proposed Increase= =New Total Points =Required Meter Size 1/?ll/
iSi.LU'/^
Meter Sizes: 1 to 30 points=5/8" f30.5 to 37 points=3/4" 37.5 and over points= 1"
9/ark 1° 26 487.00
New Meter Size Needed for New Total Points: Cost: $ (see page 1)
Current Meter Size per Utility Billing:
5/8" Cost: $ 10,095.00 (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $16,392.00
' ,
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
♦********************************************************tit******************* ******
FOR OFFICE USE ONLY Meter size must be upgraded to one (1) inch.
Current Meter Size Confirmed with UB
J Bentley 06/01/22
Signature of UB Representative Date
I:/Buudrng/Forms/WaterMeters 07012t.Add.docx Page 2