Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00434
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/31/2015
Parcel: 2S111 CA04500
Jurisdiction: Tigard
Site address: 9680 SW LAKESIDE DR
Project: Corbett Subdivision: SUMMERFIELD NO.12 Lot: 665
Project Description: Kitchen and bathroom remodel.
Contractor: UNITED PLUMBING Owner: CORBETT, COLLEEN J
PO BOX 971 9680 SW LAKESIDE DR
FAIRVIEW, OR 97024 TIGARD, OR 97224
PHONE: 503-752-8446 PHONE:
FAX: 503-491-8671
FEES
Quantity Description Date Amount
3 ea Sink 12/31/2015 $75.06
Specifics: 2 ea Tub/Shower/Shower Pan 12/31/2015 $25.02
2 ea Water Closet 12/31/2015 $50.04
Type of Use: SF 1 12%State Surcharge- 12/31/2015 $18.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $168.13
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 952-0 0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspect on date.
This permit card shall be kept in a conspicuous place on the job site until c mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building `� � FOR OFFICE USE ONLY
Fixtures Itecei�-ed
City of Tigard T%\S Date/By: fO` �� Permit No.: rs-
a 13125 SW Hall Bh'd.,Tigard,O 97223 C
Phone: 503.718.2439 Fax: 503.598. Plan By:
.,A Other Permit No.:
G�\Cj,�` jb`� Date/By: 7 S U
Inspection Line: 503.639.4175 �` �`�\�` Date Rcady/13y: Juris: ® See Page 2 for
Internet: www.tigard-or.gov
Notified/Method: Supplemental Information
TYPE OF W FEE* SCHEDULE
❑ New construction ❑ Demolition For special inforuration use checklist.
Description I Qty. I Ea. Total
Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑ Accessory building E] Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other: Fire sprinkler( sq.li.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:G // O t� Catch hasin or area drain 18.76
[ l7 , e P
Drywell,leach line,or wench drain 18.76
City/State/ZIP: ! 0 7- Z y
Footing drain(no.linear It.:_) Page
Suite/bldg./apt.no.: Project name: Manti lactured home utilities 50.03
Cross street/directions tojob site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear It.:_) Page 2
Storm sewer(no.linear fl.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
f b Dishwasher 25.02
Drinking lountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/scwer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZI P: Hose bib 25.02
Phone: ( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 3 25.02 7-s D
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 7-, 25.02 ,5-0 (�
Water heater 37.52
Business name: !• Water piping/DWV 56.29
Address: P-0 p ? f Other: 25.02
City/State/ZIP: f=0 ' r �,� P�f_.� 0 2 O Y Subtotal Sv.
Phone:(S-6 ) ! 5 ;L- e t f q& Fax:(5-6T) L111- 6' + Mininmm permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: �� Plan review (25%of permit fee)
State surcharge(12%of permit fce) Q
Authorized signature: GL:JO'trx TOTAL PERMIT FEE
Print name S C 4h C� Date: 3i I-his 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\I'LMU-PermitApp.doe 10'01j09 440-4616T(I OVICONVwEB)
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- I st 100 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- I st 100' 62.54 Medical Gas S stems'
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain- I st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional I00' 37.52 $5,001.00 to$10,000.00 572.50 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 traction 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 S 100.00 or traction thereof,to
Reinspection Fees 90.00/hr and including$50.000.00.
Additional plan review for revisions 90.00/hr 550,001.00 and up $742.00 for the first 550.000.00 and 51.20 for
(minimum charge-1/2 hour) each additional 5100.00 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 PP y'
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacu-rri/Whirl ool
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
tall as defined in OAR918-780-0040.
-Drive`F El Medical gas and vacuum systems for health care facilities.
Cuspidor/Water�spirato
Dishwasher: -Commercial ElAny 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
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./Rettig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Sery/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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Othcr Fixtures:
l:\Building\Permits\PLMF_PerniitApp.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
9680 SW LAKESIDE DR, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00434
Don Sylvester
1. Corrections are complete, plumbing final approved.
Violation Summary:
Inspector Contractor