Permit 4 CITY OF TIGARD PLUMBING PERMIT
11 1 COMMUNITY DEVELOPMENT Permit#: PLM2015-00078
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/17/2015
Parcel: 25111 DB12600
Jurisdiction: Tigard
Site address: 9430 SW LAKESIDE DR
Project: Blanchard Subdivision: SUMMERFIELD NO.12 Lot: 677
Project Description: Remodel
Contractor: ROTH HEATING&COOLING Owner: BLANCHARD TRUST
PO BOX 1265 BY BLANCHARD, LAIRD M&JUDITH M TR
CANBY, OR 97013 18707 TUALATA AVE
LAKE OSWEGO, OR 97035
PHONE: 503-266-1249 PHONE:
FAX: 503-266-3478
FEES
Quantity Description Date Amount
1 ea Clothes Washer 03/17/2015 $25.02
Specifics: 1 ea Dishwasher 03/17/2015 $25.02
1 ea Garbage Disposal 03/17/2015 $25.02
Type of Use: SF 2 ea Hose Bib 03/17/2015 $50.04
Class of Work: ALT 1 ea Ice Maker 03/17/2015 $12.51
Type of Const: 1 ea Sink 03/17/2015 $25.02
Occupancy Grp: 2 ea Lavatories 03/17/2015 $50.04
Stories: 2 ea Tub/Shower/Shower Pan 03/17/2015 $25.02
1 ea Water Heater 03/17/2015 $37.52
1 12%State Surcharge- 03/17/2015 $33.03
Plumbing
Total $308.24
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
or di question -OUNC by calling 503.232.1987 or 1.800.332.2344.
Is ued By: L COLA Permittee Signature:
L 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
City of Tigard Received Q Permit No.: L
� 13125 SW Hall Blvd.,Tigard,OR 9 7 2015 DateB : / � �' //dv/7-L+�/D 7g
■ Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
I I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: tuns: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVIciCils1 Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑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)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
IIa i-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: -L 4t3 u .K.) l(Fclt c �Q Catch basin or area drain 18.76
,1 Drywell,leach line,or trench drain 18.76
City/State/ZIP: TiO.o a A 02 91 3,2-4 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: &/}k/C.4-l�A Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
✓.ytr+4.c.rCch
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:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Q Clothes washer ( 25.02
F A L Dishwasher I 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: i n11 aL�w C.�IJ�AQO Fixture/sewer cap 25.02
f-�" Floor drain/floor sink/hub 25.02
Address:
Garbage disposal t 25.02
City/State/ZIP: Hose bib X, 25.02
Phone:( ) Fax:( ) Ice maker I 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 41.3 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 1 37.52
Business name: Li% Reltrri^• -1- (_.0()Li Water piping/DWV 56.29
Address: Ocie S ,4 Q.SoV�) �J Other: 25.02
City/State/ZIP: 0 ,yi 0Q_ 9101 3 Subtotal ,27 5• ?/
Phone:(5 j ) 6-_I2-t9 Fax:(9 3 )z66-341 a Minimum permit fee: $72.50
CCB Lic.: 19 pp g Plumbing Lic.no.: 3_450 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 33vc 3
Authorized signature: , '16), TOTAL PERMIT FEE 09-51
Print name: Kra G fl Q Date: 3/17/t 5' This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty Fee(ea) Total Square Footage: Permit Fee:
Footing drain- 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 Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
l� 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace! Please check all that apply.
Work Performed: Capped Added Relocate
❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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: -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
Water Extractor fees assessed for the sewer increase must be paid before the
WaterCloset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9430 SW LAKESIDE DR, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00078
David Young
Violation Summary:
Inspector Contractor