Permit CITY OF TIGARD PLUMBING PERMIT
IIIIII.' COMMUNITY DEVELOPMENT Permit#: PLM2022-00496
T I GAR n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/7/2022
Parcel: 2 S 111 AD03700
Jurisdiction: Tigard
Site address: 8980 SW PINEBROOK CT
Project: Snyder Subdivision: PINEBROOK TERRACE Lot: 34
Project Description: Relocating(1)clothes washer,(1)icemaker,(3)sinks,(2)tub/showers,(2)water closets.
Contractor: KTP PLUMBING CO Owner: SNYDER, RACHEL ANN
6663 SW BEAVERTON-HILLSDALE HWY 8980 SW PINEBROOK CT
PORTLAND, OR 97225 TIGARD,OR 97224
PHONE: 503-869-8776 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 12/07/2022 $25.02
Specifics: 1 ea Ice Maker 12/07/2022 $12.51
3 ea Sink 12/07/2022 $75.06
Type of Use: SF 2 ea Tub/Shower/Shower Pan 12/07/2022 $25.02
Class of Work: ALT 2 ea Water Closet 12/07/2022 $50.04
Type of Const: 1 12%State Surcharge- 12/07/2022 $22.52
Occupancy Grp: Plumbing
Stories:
Total $210.17
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"etarted within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to fellow the rule§ adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You t/aq obtain,a'cop/Of the rules
Issued B
Y: Permittee Signature: ��(,{,-t
l ` J
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 USE ON].)
Cityand Received Permit No: ��,� -� cop
13125 of Ti SW Hall Blvd.,Tigard,OR 97223 Han Review
(al,,
■ ' Phone: 503.718.2439 Fax: 503.598.1960 �1e By Other Penn No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: hair ®See Page 2 for
Internet: www.tigard-or.gov Notifed/Method: Supplemental Information
_ +"tx" r':. .. -2; rc' r'�`,tf,c t r�2. Y ... Fi('�6,J
' eeey���eee000ttn�I ' , ' hS?3.•,C��`.ri' � .� -ywxiv. {t` :.t� .. .. -For
_ 1 - .
ist
Q Ney�eonstruction 0 Demolition
Forspecral injormelionQty use ebteilPa
N�J/ Description I Qty. I Ea. ( Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR 1 bath 312.70
�s'ro ltrl (,`, :)r c ),yr;�cc " :: O
t• 1-and 2-family dwelling ❑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 ❑Other: Fire sprinkler( sq.ft.) Page 2
1C Site utllihes.
arts t. 44i1 C L� • yki t' �n 1)"
Catch basin or area drain 18.76
Job site address: �)'o s /4J ��!/G - Drywell,leach line,or trench drain 18.76
City/State/ZIP: C/.a..,(7./) Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I 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: I Lot no.: Fixture or item:
Bacldtowpreventer 31.27
Tax map/parcel no.:
Backwater valve 12.51
js">[ ? ?-i`Y[jf 7 r:;c1 s< ! 25.02
_ _ - Clothes washer
I4 k/' Dishwasher 25.02
(Hle-D K Drinking fountain 25.02
Y Ejectors/sump 25.02
LNy ,E ,_ Expansion tank
',S.E1S?�ti t, c?Jr�i� - • ','l �'I- ... 12.51
25.02
Fixture/sewer cap
Name: 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
f ' - ' 11.j CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name: 12.51
Primer
Contact name: � "�� if--- - Roofdrain(commercial) 12.51
Address: 116/?-JD/"- --417- - Sink/basin/lavatory 325.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan Z 12.51
Urinal 25.02
E-mail:
Water closet 25.02
.-_, 'VC esr�;gp-rfe;;: rye.tF-' .
Water heater 37.52
Business name: j7 f7L(Jyrig e , I Water piping/DWV 56.29
Address:66// c/N Zai, 'e /44,7 ' q 9 Other: 25.02
City/State/ZIP: 4bk d- - 9 7 Z ZS- Subtotal
Minimum permit fee: $72.50
Phone:(SD3) 626.Sg 7 7.6 Fax:( ) Plan review(25°h of permit fee)
CCB Lie.: !S1/e/ J Plumbing Lic.no.:3LJ34,//,P3 State surcharge(12%of permit fee)
Authorized signature: / TOTAL PERMIT FEE t�(^
((), L 4-
Date:42-7�i ,�+ This permit application expires if a permit h not obtained within 180 days
Print name: /� after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
i:lBuilding\PermilslPLMU-PermilApp.doc 10/01/09 440.4616T11o/02/COM/WBB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: vvy Residential Fire Su t t ression S stems:
'' m '{l',.y. ,14,c� « ,, g' rt �i , o'y'. ' r''`tg,!el'i:r6l'46' 0-c4 '. ! 'M:A'.t . Vic-... J '"%t,v1
Footing drain-1"100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 3752
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 41�f� r V 4 ,�macc r 'd, ,ai$r
62.54 �'1SI�Is�3]> �p`.S`.a�?.VY4',�s0 __ � �_
Storm&Rain Drain-1st 100' $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
, - r each additional$100.00 or fraction thereof,to
a : 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurate!y report fixtures could result in increased sewer fees . . R I_ i 1 t I b
QiTaetity b"yaFjfit�re IrPe Plan review is required for any of the following.
Fixture 7ypefor ;"s a` R jiI ttI Please check all that apply.
-"woik Performed. .. Capped i0eid Relocati?.
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Iacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash. -Each Stall as defined in OAR9I8-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" °
a" ■ 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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures.
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