Permit CITY OF TIGARD PLUMBING PERMIT
s" COMMUNITY DEVELOPMENT Permit#: PLM2023-00003
Date Issued: 1/9/2023
T I G A R .) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S102AB00203
Jurisdiction: Tigard
Site address: 9425 SW CENTER ST
Project: Gillespie Subdivision: MARIELL Lot: 3
Project Description: Bathroom addition for remodel:(1)sink,(1)tub/shower,(1)water closet, and(1)water piping/DWV. WATER
METER UPSIZE REQUIRED.
Contractor: MICHAEL S DALY PLUMBING&CONSTRUCTION Owner: GILLASPIE TRUST
1010 BEARCREEK DR BY GILLASPIE, DAVID&ELAINE B TRS
MOLLALA, OR 97038 13621 SW MOUNTAIN RIDGE CT
TIGARD, OR 97224
PHONE: 503-896-7978 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 01/09/2023 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 01/09/2023 $12.51
1 ea Water Piping/DWV 01/09/2023 $56.29
Type of Use: SF 1 ea Water Closet 01/09/2023 $25.02
Class of Work: ALT 1 12%State Surcharge- 01/09/2023 $14.26
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $133.10
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 oft rules
Issued By: Permittee Signature: ./44,aj c
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 OFFICE USE ONLY
Received permit No.:
City of Tigard Date/By: i/� �3 �77-' `N)��3`��y�
■ 13125 SW Hall Blvd.,Tigard,OR 972?,1�„ nu Plan Review1111 r( Other Permit No.: 1� �3
,. •
Phone: 503.718.2439 Fax: 503.598J 9 ZU?? Date/By: 5r2A
Inspection Line: 503.639.4175 Date Ready/By: awu: Hi Sec Page 2 for
Internet: www.tigard-or.gov TIGARD - Notified/method: S lemeotal Information
-❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utilityconnection)
�'' 7 E;• 9 r E.r]‘Li.'"iz, t _ SFR(1)bath 3.7 437.78
SFR(2)bath
1-and 2-family dwelling 0 Commercial/industrial SFR(3)bath 500.32
Accessory building ❑Multi-family Each additional bath/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
_ - _jl,. 't E`<(-t L)`:yatl} `�A:ir 1 -- Site utilities:
Catch basin or area dram 18.76
Job site address: 9/f . - S 0,..) ( pw1 1 v S Drywell,leach line,or trench dram 18.76
City/State/ZIP: -'rt b Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: I Project name: t,i J 4/__GS f Ger.- Manufactured home utilities 50.03
Cross street/directionsManholes 18.76
to job site: 18.76
s tr-) �'/5 � Rain drain connector
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:
Backflow preventer 31.27
Tax map/parcel no.: Backwater valve 12.51
r. ' 'l t')s c7 ;' Clothes washer 25.02
,� / „-,_ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
___ cat'! .,, L:
Fixture/sewer cap 25.02
Name: Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Fax ( ) Ice maker 12.51
Phone:( ) " _• Interceptor/grease trap 25.02
f._.; $�-,-F G `•y gGr cl"Urt :r'r :' : ��rs"..
Medical gas(value:$__) Page 2
Business name: `A�,� es^ y! fit•„ Primer 12.51
Contact name: J Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02 /
City/State/ZIP:
Solar units(potable water) 62.54
12.51
Phone:( ) I Fax: :( ) Tub/shower/shower pan
Urinal 25.02
E-mail: Water closet 25.02 /
CON1tAC1'UR ._ r. Water heater 37.52
Business name: Pft) y t'}.-ky1pq t tivl Water piping/DWV 56.29 /
Address: \' f e e-- 'Dr Other: 25.02
1 �t 0 I�Q(� Subtotal
City/State/ZIP: D( 1.L 1► Minimum permit fee: S72.50
Phone: --d 1 kg - ?CI ? `( Fax:( ) Plan review(25%of permit fee)
CCB Lic.: -II.7 e h I A(/ Plum ng Lic.no.: -'f t3 26 r - State surcharge(12%of permit fee)
Authorized signature: :d / , 7/1123 TOTAL PERMIT FEE
„/ J.k.� _3 I This permit application expires if a permit is not ualained within 180 days
Print name: Aft , �7 Z, I Date: 2 after i it has been accepted in Industry
`v'/ � / omp e.
*Fee methodology in by Tri-County Building Industry Service Board.
11Building1PetmnstFLMU-PartmApp.doc 10/01/09 4404616T(10/02/COM/wEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su t t ression S stems:
rt• y- •w ,.. J S
V1i, .. ;9.'ak .a3,(;,',.i; ' - b ` � aF' v' '' �. . 5 llr3Jf `.i_':tx t �e 4....
Footing drain-l"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:eater $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 -" , -,�
'-t ', J :� 1;S"VtiY rv(.vJ - - < r_' a�--. • ''n,.
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
each additional$100.00 or fraction thereof to
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*. -° ,6..„5.46s'r '
Qdagttty byrF.titre k Pax* Plan review is required for any of the following.
Fixture Type for �*+" Rep7i«/3- Please check all that apply
capped<, ; nd4gd „ Aetocate;,
❑ 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
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial 0 Any multipurpose fire sprinkler system.
Domestic 0 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" 4 +,"�1'.:es' J✓FL `, ' .r33r Sr C '1;1:.
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 MachfRefrig.Drains Comments regarding fixture work:
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
WaterCloset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
1/9/23, 10:42 AM ExportStreamingHandler.ashx
RECEIVED
AN---9 mg
Water Meter Fixture Unit Worksheet for Additions/Re
3UILDING DIVISION
Please complete the following information:
Customer Name: Dual.`` C I r S E. 61 I1 jp l°
Service Address: Street/Suite#: 25 Si.( C ( .. •
City:Ttt, 7_ State: GR.- Zip_97223
Phone Number: cr { .An • ?yam$ Email: I-tblu-t C1-161t,L..91050 • Cori
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 1
Quantity Value Total Addition Value Total
Bar sink x 1 = x 1 =
Bidet _ x 1 x I =
Clothes washer y x 4 = .i- x 4 =
Dishwasher I x 1.5 = I ,S x 1.5 =
14 Outside Water Spigot 1 x 2.5 = -z.5 x 2.5 =
Water Spigot,each add'J x 1 = I x 1 =
]Kitchen sink 1 x 1.5 = l,5 x 1.5 =
Laundry sink x 1.5 = x 1.5 =
Lavatory(bathroom sink) 1 x 1 = I I X 1 = I
Water closet,i.6 GPF(tcilet) I x 2.5 = 'z.r7 1 x 2.5 = 2,S i
Bathtub/whirlpool x 4 = x 4 = i
Shower stall x 2 = x 2 =
Bath/shower combo I x 4 = 4 1 x 4 = f
Current Points: le, Proposed Increase: 7,5 1
r
Current Points+Proposed Increase= 25.5 =New Total Paints =Required Meter Size [
Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=s!," 37.5 and over points=I" I
r
1
F
New Meter Size Needed for New Total Points: Cost: $»CALA -OD (see page l) 1
Current Meter Size per Utility Billing: `C�� Cost: S 112.. te:).a'• (seepage l)
i
t
New Meter Size Cost minus Current Meter Size Cost= $ 1"—I`t7-t..D - O. C.)
(This is Your Cost to Increase Meter Sire Lure to Additional Fixture Units)
******************************ee***ssis******$*+ *******I************a*******'**4+.*s 1
FOR OFFICE USE ONLY t
Current Meter Size Confirmed with UB 'An I 7.O 2-2—
Signature ofUB Representative Date
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