Permit CITY OF TIGARD PLUMBING PERMIT
: COMMUNITY DEVELOPMENT Permit#: PLM2015 00143
Date Issued: 05/07/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104CC00600
Jurisdiction: Tigard
Site address: 14183 SW MISTLETOE DR
Project: Ikeda Subdivision: HILLSHIRE ESTATES NO.2 Lot: 111
Project Description: Alterations to(1)tub/shower,(1)tub&(1)shower.
Contractor: ALL PRO PLUMBING SERVICES LLC Owner: IKEDA, MARLENE K
15712 NW OVERTON DR 14183 SW MISTLETOE DR
BEAVERTON, OR 97006 TIGARD, OR 97224
PHONE: 503-579-5555 PHONE:
FAX: 503-259-2555
FEES
Quantity Description Date Amount
3 ea Tub/Shower/Shower Pan 05/07/2015 $37.53
Specifics: 1 12%State Surcharge- 05/07/2015 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment- 05/07/2015 $34.97
Plumbing
Class of Work: ALT
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 No -- .- ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-00 0090. You may obtain a copy of the rules
or dir- questions to O .y cal.ng 503.232.1987 or 1.800.332.2344.
Is ued By: Permittee Signature: if'
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 FOR OFFICE l SF O\I 1
E C E I\f E D
City of Tigard Received
Date/By: 7 /5--(s_ l,___y. ) Permit No.:PL
l6-w M
• 13125 SW Hall Blvd.,Tigard,OR 97223
:IN I Phone: 503.718.2439 Fax: 503.59> �0 7 2015 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 Date Re B orris: El See Page 2 for
I l v A R D Internet: www.tigard-or.gov o g
OF T��','1Pi�� Notified/Method: Supplemental Information
❑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)
CATEGO SFR(1)bath 312.70
❑ 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: 14 i , Y V ✓j1 i S-j'I{tz4-zjer Dl' Catch basin or area drain 18.76
City/State/ZIP: r� �/� Q� ate] Drywell,leach line,or trench drain I 18.76
s o ` Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: .t'4r- ._ 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 It.: ) Page 2
Subdivision: l Lot no.: Fixture or item:
Tax map/parcel no.: Baekflow preventer 31.27
y DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
C-Ltp Ord S 1 1411-f#' 1:"17 C-Pr 1'- c� S A A 07-Jj . ,dishwasher 25.02
t -// /Lr /x 1/ ari�, .:.,�, •` i Drinking fountain 25.02
V' . C (4LOtj C r1J 7 �i•i:r..."�=: -- ,.• Ejectors/sump 25.02
ROPERTY OWNER F ❑ TENANT M Expansion tank 12.51
Name: Ma i t 17\ __ y I P Fixture/sewer cap 25.02
Address: 1 41 S� �(/� is • .t e D� Floor drain floor sink/hub 25.02
l .1.---, af� q 7� _Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) A306(03-73 Fax:( ) Ice maker 12.51
❑ APPLICANT 1 ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: - ,r Medical gas(value:$ ) Page 2
a Primer 12.51
Contact name:
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 st3 12.51 /A 57
E-mail: Urinal 25.02
- Water closet 25.02
CONTRACTOR
r ( f/O Water heater 37.52
Business name: J i umbG/ .4 Water t m WV 56.29
/ ` /�� P�P� S�
Address: 1 57 / 2 i U l/.J O v IN Other: 25.02
City/State/ZIP: /1Vill (� q-l)O(o Subtotal
Phone:503 5 7g ��55_ Fax:( ) Minimum permit fee: $72.50 '7a .S7D
CCB Lie.: 4 s ' Q y 43 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) g.7t)
Authorized ii l / P 6 71 TOTAL PERMIT FEE g 1.4O
Print n. ' s .4 i / ,&di, Date: This permit application expires ifs 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:1 Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
i
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-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 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
eachadditional$100.00 or fraction thereof,to
t Cr SpeC O 111.1111Ell. 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*.
--- -
Quantity ty b lure 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
-Jacuzzi/Whirlpool engineer.
El Car Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial ID 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"
Isometric or Riser Dia. am
• Isometric or riser diagram is required for new buildings
-Car Wash Drain _ that meet the •ualifications 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 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:
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