Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit#: PLM2015 00184
T I c ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2015
Parcel: 25111 CC06100
Jurisdiction: Tigard
Site address: 9940 SW CENTURY OAK DR
Project: ORTIZ Subdivision: SUMMERFIELD Lot: 84
Project Description: Replacing dishwasher,kitchen sink,and(2)lavatories.
Contractor: OWNER Owner: ORTIZ, PAUL&DENISE
PAUL& DENISE ORTIZ FIGUERAS,ANTHONY
9940 SW CENTURY OAK DR 21740 SW 109TH TER
TIGARD, OR 97224 TUALATIN,OR 97062
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 06/09/2015 $25.02
Specifics: 3 ea Sink 06/09/2015 $75.06
1 12%State Surcharge- 06/09/2015 $12.01
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 follo '' rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-Os' '• • copy of the rules
or direct questions to OUNC by calling 503.232.198 :e 3=2344.
/� ''
Issued By: Permittee Signature: r
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 USE ONLY
City of Tigard Received _
Permit No.:
i 'r 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: /!{/1� Pln�/Z(7 J /
Plan Review / _
7.
Phone: 503.718.2439 Fax: 503.5 9 e IV E D Date/By: Other Permit No. u_�(S----.00_qv i
Inspection Line: 503.639.4175 L� '�
T I G A R D Date Ready/By: rpt El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: /-r� Supplemental Information
TYPE OF WORK JUN 9 Z015 FEE* SCHEDULE
❑New construction ❑(Brr:lielf TIGARD For special information use checklist
D�v'S�ON Description I Qty. I Ea. I Total
VA Addition/alteration/replacement �I 4�1� New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
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:
R ' 1f CC� f `/ O�Ic D Catch basin or area drain 18.76
Job site address: T n
Drywell,leach line,or trench drain 18.76
City/State/ZIP: T�1G 0,e( �.( CC-7)4'A '
J /C7' Footing drain(no.linear ft.: ) _ Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear II.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Sit.,`to r C( �, I Lot no.: Fixture or item:_
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/ 'R CE ,6(e-" �� ! Clothes washer 25.02
!�/ Dishwasher ?C. ) 25.02 2 O'2_
S.lN/C_ f (2) -eL5 Drinking fountain `,,/ �25.02
Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
%'1.. 4_ Q{ � Fixture/sewer cap 25.02
Name: �I
Floor drain/floor sink/tub 25.02
Address: q c 4 J S C V14- r7 �a� Garbage disposal
25.02
City/State/ZIP: T� q W. Hose bib 25.02
Phone:( ) c� Fax:(, )) Ice maker 12.51
L C
❑ APPLICANT ONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact namc: * O v--1- \- __ Primer 12.51
Roof drain(commercial) 12.51
Address: Z.-S - L. v1..r:t`k L f"\ Sink/basin/lavatory `3 25.02 75'06
City/State/ZIP: S L∎ tiWN 0&- l'l/015 Solar units(potable water) 62.54
Phone:( 771) -7 C2. ,4 C Z,3 Fax::( ) Tub/shower/shower pan 12.51
E-mail: /hp, Pp{ ..�' ,,r t COy� Urinal 25.02
Water closet 25.02
RACTOR
Water heater 37.52
Business name: OA/A/Er_ Water tin
PP g/DWV 56.29 I
Address: Other: ' 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50„....4e r
Plan review (25%of permit fee) t,
CCB Lic.: - . t 1 Lic.no.:
State surcharge(12%of permit fee) 41-1;`f'ry e i
Authorized signature: ,-_ TOTAL PERMIT FEE
` a This permit application expires if a permit is not obtained within 1 ys
Date: after it has been accepted as complete. i li,L 7
*Fee methodology set by Tri-County Building Industry Service Bo
1'\Building\Permits\PLMU-PermitApp.doe 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-I51 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 Valuation: Permit Fee:
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
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: =1'ub/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"
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: -LavBar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filler increase of sewer EDU5,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:
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
9940 SW CENTURY OAK DR, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
FAIL
PLM2015-00184
David Young
No access for inspection, no one home. 9:19 am
Violation Summary:
Inspector Contractor
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
9940 SW CENTURY OAK DR, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00184
David Young
Violation Summary:
Inspector Contractor