Permit (25) CITY OF TIGARD PLUMBING PERMIT
IIICOMMUNITY DEVELOPMENT Permit#: PLM2023-00507
T[G A R fD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/5/2023
Parcel: 2S102BC09600
Jurisdiction: Tigard
Site address: 10162 SW WOODARD LN
•
Project: Huber Subdivision: 1998-119 PARTITION PLAT Lot: 3
Project Description: Relocate water piping location around breaker box.
Contractor: OWNER Owner: PAPP, LAURA
HUBER,AKOS
2703 NW RALEIGH ST
PORTLAND,OR 97210
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 12/05/2023 $56.29
Specifics: 1 12%State Surcharge- 12/05/2023 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment- 12/05/2023 $16.21
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 ares/et forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: 4/� l
Permittee Signature: /�,
Call 503.639.4175 by :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 DateiBy: VD6✓ 1
;I w 13125 SW Hall Blvd.,Tigard,OR 97 }di,_ i, Date/Bey: 3e� r aj v� Petmit � �. �,
Plan Review �^
Phone: 503.718.2439 Fax: 503.59 I6lb 1-''It.'' Date/By: Other Permit No.:
f I( �t t> Inspection Line: 503 639 4175 ��� Date Ready/By:
Internet www.tigard-or.gov OF T I y y a473 s Jurts S See Page 2 for
y+ Nomfied/Method ✓� Supplemental Information
s i ',. P) s ;,,. .yu 6a t"� "'.tX . r k Ya am§fit E r .��, r apt +S^t xr`t' r
❑New construction ['Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
ilk,44;i1;;'.......447.,. ,, Ms:w t,7. , V is r SFR(1)bath 312.70
g 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
ElAccessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other
n v ° Fire sprinkler( sq.ft.) Page 2
,,_1 , .. .;: t i* f .-, _ f -; ,..g,f'`.,t'a ', n : Site utilities:
Job site address: t 0 ((1 Jj7 097� y7 F /_a Catch basin or area drain 18.76
City/State/ZIP: " -76_,c r7 O rz y 7-22�71' Drywell,leach line,or trench drain 18.76
If J 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
Fj P-O°k9i196- 4ba 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
j4 Backwater valve 12.51
'' ", ` Clothes washer 25.02
W4- P/p/k6 - To
E6- g&-- (76 - --p Dishwasher 25.02
Drinking fountain 25.02
2
f' ;: Expansion tank 12.515
Name: /1-
&d 5 / 1096-2 Fixture/sewer cap 25.02
Address: / l 16'2, SW & 7.A.� v Floor drain floor sink/hub 25.02
` (/1/ r l IC. Garbage disposal 25.02
City/State/ZIP: 1/6- rj d£ 51' - � z Hose bib�t/� ✓ 25.02
Phone:(Fa 3) g 1 C L I Fax ( ) Ice maker 12.51
��
* „1 s» .. Interceptor/grease trap 25.02
r H° t .4
Business name: P> oEE < Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
sit t+ i ,.,- Water closet 25.02
° „ . ,.,, " :� � . .�t,? 'a Water heater 37.52
Business name: 1 7 7 1' ow,v��
a w /v F- Water piping/DWV C 56.29 i
Address:
Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signature: lj-1„.....„,___s___ ,-j-------' TOTAL PERMIT FEE
Print name: lei-i<0 S I ti 1 Date: /Z`c'rz 3 This permit application expires if a permit is not obtained within 180 days
(/12, ( ( after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe lost 09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: ... Residential Fire
Suppression
Systems:
4 t :1 i rp
e . . .. -� mow: . ,..,:. :. ,. -,a .s: ph
Fo
ting drain-l"100' 50.03 0 to 2,000 $121.90
Footi drain-each additional 100' 37.52 2,001 to 3.600 $169.69
3,601 to 7,200 $233.20
Sewer-1 100' 62.54 7,201 and greater $327.54
Sewer-each•.ditional 100' 37.52
Water Service- t 100' 62.54 Medical Gas Systems:
Water Service-eac' dditional 100' 37.52 fir; .
, � - ,,,`,,:vim ' z„*�K+�, `..phi
Storm&Rain Drain- 100' 62.54 $1.00 to$5,000.00 MinimufYt,fee$72.50
Storm&Rain Drain-each dditional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the,,first$5,000.00 and$1.52 for
ry Y � 1
each addmonal'$490.00 or fraction thereof,to
and including$10, 00.
Inspection of existing plumbing or ..r $10,001.00 to$25,000.00 $148.50 for the first$1'01000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or`*action thereof,to
(minimum charge-1/2 hour) and including$25,000.00. 'w,
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 aild$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
accurately report fixtures could result in increased sewer fees*. '1 g,' o ,, _: 4.05**,..- m 1 i.i', :' . .. .
Quantiy by Fixture Type Plan review is required for any of the following.
Fixture Type for„, Replace/ Please check all that apply.
Work Performed Capp ` Added ,,Relocate
- ed ' ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 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
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print Name of Permit Applicant
L/0512-0Z.3
Signature of Permit Applicant Date
Permit#: VW" -OU 50 7
Address: ( v I (, r�o< ,ryc �*" ��
i :ntid��
Issued by: tg, Date: L (r✓'
This Copy for Permit Offices