Permit u. 1 i�` CITY OF TIGARD PLUMBING PERMIT
I �,
COMMUNITY DEVELOPMENT Permit#: PLM2015-00380
iq' 13125 SW Hall Blvd ,Tigard OR 97223 503 718 2439 Date Issued: 11/12/2015
TIG,i Parcel: 2S112CB07700
I
Jurisdiction: Tigard
Site address: 15143 SW KENTON DR
Project: CEDENO Subdivision: ASHFORD OAKS NO 2 Lot 91
Project Description: Removing(1)shower and adding(1)shower in place of tub
Contractor: UNIVERSAL PLUMBING Owner. CEDENO, JOSE D
8811 SW SPRUCE ST BARLOW, MARILYN J
TIGARD, OR 97223 15143 SW KENTON DR
TIGARD, OR 97224
PHONE' 503-452-7480 PHONE
FAX
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 11/12/2015 $12 51
Specifics: 25 Misc Other Fee 11/12/2015 $25 02
1 12%State Surcharge- 11/12/2015 $8 70
Type of Use: SF Plumbing
Class of Work ALT 35 ea Minimum Fee Adjustment- 11/12/2015 $34 97
Type of Const Plumbing
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 are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules
or direct questions to OUNC by calling 503 232 1987 or 1 8 44.
Issued By: Permittee Signature: A0AIIIIIIIPPIPPP �j
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 .'t-titp
City of Tigard Received
y '� Date/By Permit No
a 13125 SW Hall Blvd.,Tigard,OR 972 Y '�
n� Plan Review ��`
_ Phone: 503.718.2439 Fax: 503.598.1 960 '1,0C3 Other Permit No/ " 1c+01 c .o 26
�q Date/By
Inspection Line: 503.639.4175 1 N Date Read /B inns ® See Page 2 for
TIGARD (-\\I N. Ready/By. `�� g
Internet: www.tigard-or.gov ��Notified/Method iZ1( Supplemental Information
TYPE OF WORK �v OV I j., cA 1 FEE* SCHEDULE
❑New construction ❑ Demo ll���c� For special information use checklist.
�p Description Qty Ea. I Total
(KAddition/alteration/replacement ❑Ot' ) New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312 70
❑ I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry g ❑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: / 5 7 I r/ „�4 , �,(J (// Catch basin or area drain 1 8.76
y / ���j� ��2-2 I Footing 1,leach line,or trench drain 18.76
City/State/ZIP: 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 1 8.76
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
DESCRIPTION OF WORK Backwater valve 12.51
1 ._SG,�,��� d4 e— Clothes hesher 25 02
i Dishwasher 25.02
r'f---b , - e't ,5' 1*vt, "--)7_ f/II '�/C., c €__ Drinking fountain 25.02
1C7 Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25 02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25 02
Business name: ,:z. ---,,w,. Ga or I x e (....Lc___ Medical gas(value:S ) Page 2
Contact name: e-c Printer 12.51
C�, kJ L�, Roof drain(commercial) 12.51
Address: i f ? r 5 t� I �'P--t✓rl L .4 i( - / Sink/basin/lavatoiy 25.02
City/State/ZIP: t f Lam/ a 7-z'�3 Solar units(potable water) 62 54
Phone:9 3 )) 6 r 2-c/3z-A Fax: :( 3 ) Z( k2....(5 Tub/shower/shower pan c 12.51
/).. y—/
Urinal 25.02 G e - b,.„0 T.,,-,,_ , . p-✓✓
Water closet 25.02
CONTRACTOR
/ Water heater 37.52
Business name: �? /�� IvPJJ,!�L Ju �l�(� Waterpipinng/DWV 5629
Address: F�I ! 5 �lt����Rucc_c_,I j Other�.b/� 0 L t i ( 25 02 ��,c/�City/State/ZIP: 77 CC,tom//,, 9 I S 4.' /`n1�L� Subtotal
Phone:(C ?) �/( , 7 o (1 . Fax:( ) Minimum permit fee: X72 50 ��, �
CCB Lie.: ( c- .( 2_ 1 J7 i7 Plumbing Lie.no.: h -7/P Plan review (25%of permit fee)
State surcharge(12%of pennit fee) f
Authorize. siature: i 7/
•n TOTAL PERMIT FEE •(..2-G
Print name: _ Date: �)
�- This permit application expires if a permit is not obtained within 180 days
.w �� i/, it `t/ after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
IA Building\Penults\PLMU-PcnmtApp 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-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
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
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
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath. -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each S ❑ New exterior plumbing site utilities for any complex structure
Drive Stall al u 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 OAR9I 8-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink -2'•
3.. Isometric or Riser Diagram
4' ❑ 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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:\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
15143 SW KENTON DR, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00380
Jeff Grove
Violation Summary:
Inspector Contractor