Permit Ili CITY OF TIGARD PLUMBING PERMIT
N . COMMUNITY DEVELOPMENT
Permit#: PLM2022-00511
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/19/2022
Parcel: 1 S 134DA05600
Jurisdiction: Tigard
Site address: 11343 SW 105TH PL
Project: GANTNER Subdivision: NODAK Lot: 4
Project Description: (1)shower pan for tile shower.
Contractor: LARSEN&SON PLUMBING CO INC Owner: GANTNER, ERIC C
8537 SW 54TH AVE 11343 SW 105TH PL
PORTLAND, OR 97219 TIGARD, OR 97223
r
PHONE: 503-246-7004 PHONE:
FAX: 503-246-8336
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 12/19/2022 $12.51
Specifics: 1 12%State Surcharge- 12/19/2022 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 12/19/2022 $59.99
Class of Work: ALT Plumbing
Type of Const:
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 the rules
Issued By:v`9'£' - Permittee Signature: cy!'` ��`
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.
Plumbin>? Permit Application
Building Fixtures FOR OFFICE USE ONLI'
}ag F ? AIF IF:, Received / Permit No:�
City of Tigard ,. 1.,._. „. Datemy: /�l11 �d- �- 9.52?`tiZ'i l
'PI13125 SW Hall Blvd.,Tigard,OR 97223 ,. Plan Review Other Permit No.:
■ Phone: 503.718.2439 Fax: 503.598.10A-` 5 Heresy:
Inspection Line' 503.639.4175 Date Ready/By: rum la See Page 2 for
TIGARD Internet: www.tigard-or.gov CITY O user'* _NotiSed/Merhod; :�,_ Supplemental Information
For special information use checklist
❑New construction 0 Demolition Description I Qty. I Ea. I Total
4 Addition/alte rim/replacement 0 Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
SFR(1)bath 312.70
SFR(2)bath 437.78
-and 2-family dwelling 0 Commercial/industrial SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
-i. 'r;.; c`iL1°i` ;l .t.`ii} ' �_1"`[[P Site utilities: 18.76
l Catch basin or area drain
Job site address: t 13 4 3 "5� yt/ I bS -pi Drywell,leach line,or trench drain 18.76
City/State/ZIP: "70,r- vW` / U� C1 } 3 Footing drain(no.linear R.: ) Page 2
Suite/bldg./apt.no.: l Project name: Gram -.,/ - 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: J Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.: Backwater valve 12.51
Clothes washer 25.02
H4COo n4 c 4 O'1'I I Dishwasher 25.02
1`3 0 OAAYbnra' wt� �,,� \- do � C/ Drinking fountain 25.02
5)40� Ejectors/sump 25.02
�,ej- Pr I i' J O r1 _ - 12.51
,.t i' Expansion tank
Fixture/sewer cap 25.02
Name: (1 C eti.v) e Floor drain/floor sink/hub 25.02
Address: 11343 33 s1,0 f 0 rt, pi Garbage disposal 25.02
City/State/ZIP: 113v4k.co(ok 62 ( ?-aD- Hose bib 25.02
Phone:( 9 5 0 3 C. 3 5Z7 Fax:( ) Ice maker 12.51
1 1 Interceptor/grease trap 25.02
Medical gas(value.$ ) Page 2
Business name:TL)cQ f-koo -P S1GI Y) Primer 12.51
Contact name: !4 YVl /r t G EI.(e 4uJ Roof drain(commercial) 12.51
Address: rf D c LL) ,3 ) c Av-e Sink/basin/lavatory 25.02
City/State/ZIP: -pc,r a v-ct Oi Of 7--D-( 9 Solar units(potable water) 62.54
Tub/shower/shower pan i 12.51 /ra„r/
� Phone: 3 ) Li 5-9 �3 S ' Fax::( ) Urinal 25.02
7 J E mail: Y.,tyv) c (rC 1 G l
r `'t00- C0 P'.1 Water closet 25.02
rCn_t ,
.- t4 C c ry iot;r c r u�3 Water heater 37.52
Business name- n .e 2 . .,,,{G 19,E1.(r M�L, a�'yne Water pipingiDWV 56.29
Address: ?53 SW �5 4 �- Other: 25.02
City/State/ZIP:
po,--ka tea ®R q 7-a 19 Subtotal id_s-)
Minimum permit fee: $72.50 7A.
Phone:Ir:50}j) anLI-& -9-00 Li Fax:( ) Plan review(25%of permit fee)
CCB Lie.: 3 7 c"�1 �/ Plumbing Lic.no.: 4,+ / - State surcharge(12%of permit fee) �, 7�
r P? G�
Authorized signature: TOTAL PERMIT FEE $1 ,r})
This permit application expires if■permit is not obtained o I80 days
Print name: M fylGF-�l er7 Date: ) I ej l�3 I after it has been accepted al complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.meildinglPerntil5lPLM11-PumiiApp.d°c 10/01/09 4464616T(10/02/COM/WEB)
Plumbing: Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su r ression S stems:
"eS .r. `n {.` f ."'RS j�iig .,. a§ L. z f !(.� , \i$-,yT . :A,',,;]*.'''-' t '1!PP' .v . + it Al!,
1 � �Si v. 7Vi Ar 4_:..-y-_ F r r''AYE ly.liP r7?_+ a 'L �S - 4LP C.. �.-�Y . ]n L`�
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 S stems:
Water Service-each additional 100' 37.52 ,- , �;yc'� "' + S' `r <'
62.54 '.f�lli itt)i i . I%srYi4l.ifilf, 2 ;- : r
Storm&Rain Drain-1st 100' $1.00 to$5,000.00 Minimum fee$72.50 1
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
-.; each additional$100.00 or fraction thereof,to
'ffei� Y 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/ r 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
accurately report fixtures could result in increased sewer fees* " I? A l 1 I ;
Quantity by>Fjttline ype r r Plan review is required for any of the following.
Fixture-Type4bt' ' ' , ' " xepncer Please check all that apply.
"Work Performed. Capped''j, Added Relocate
El 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 El New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
shwash -Commercial al ❑ Any multipurpose fire sprinkler system.
Commerc ❑ Any complex structure as defined in OAR918-780-0040.
estic
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" r
3„ emu' . , t • ...• •A_ •.. , . . .
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. -LavBar 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 EDL1s,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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