Permit (178) CITY OF TIGARD PLUMBING PERMIT
9
COMMUNITY DEVELOPMENT Permit#: PLM2016-00009
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/12/2016Parcel: 2S110BAO660O
Jurisdiction: Tigard
Site address: 12102 SW WILDWOOD ST
Project: Smith Subdivision: SHADOW HILLS NO2 Lot: 49
Project Description: Replacing Jacuzzi tub with smaller,replacing lays and toilet. Relocating shower.
Contractor: WESTERN PLUMBING Owner: SMITH,VISTON& SUSANN
9460 SW TIGARD AVE SUITE 101 REVOCABLE LIVING TRUST
TIGARD, OR 97223 BY VISTON/SUSANN SMITH TRS
12102 SW WILDWOOD ST
TIGARD, OR 97224
PHONE: 503-639-5296 PHONE: 503-620-5416
FAX: 503-684-9015
FEES
Quantity Description Date Amount
2 ea Lavatories 01/12/2016 $50.04
Specifics: 2 ea Tub/Shower/Shower Pan 01/12/2016 $25.02
1 ea Water Closet 01/12/2016 $25.02
Type of Use: SF 1 12%Stale Surcharge- 01/12/2016 $12.01
Class of Work: ALT Plumbing
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 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. Vpu may obtain a copy of the rules
or direct quest i o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued ��
Y4���"'Lil Permittee Signature:
�
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.
PlumbinE Permit Aaplicati"�� ,J�S�3�
Building Fixtures Y t' 1 r
g Received 2/�„ I•JMi�����
Ci of Tigard ,'N 1 2 '�P iF Dc".By: / Al lgJ Permit No. GI fOH
• 13125 SW Hall Blvd.Tigard.OR 97223 Plan Re.iew
Phone: 503.718.2439 Fax: $Oi59$ly(>jl AA,, '.t �r
Date By. Deter Pennil No.:
Inspection Line: 503.6344175 l JA• A�i;4fl� Date Ready By: tarts ® See Page 2for
Interact: www.11gat'd-ongov ,{� 3 fI N.Bbed'Method: Supplemental Information
VFUZ
❑New construction ❑ Demolition Forspecial in ormatlon use checklist.
Description Qt Ea, Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 0-for each utility connection)
SFR(I)b312.70 arb
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ElMulti-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑Other:
Fire sprinklex( sy. ft.) Paget
`JOR Sft VOURMATWIR AND LOCATION Site utilities:
Job site address: Z 0 2 S�C.� W.� S Catch basin or arca drain 18.76
Drywell.]each line,or trench drain 18.76
City/State/ZIP: 2 Z' Footing drain(no.linear ft.: I Page 2
Suite/bldg./apt.no.: Project name: Manutacmral home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer Ino.linear If.: I Page 2
Water service(no.linear ft.:-) Page
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventei 31.27
0IPPION OF-WORK Backwater valve 12.51
IeI r Clothes washer 25.02
/ /t , ..1;/2:.L • U 1Z/ Dishwasher 25,02
xJ lO /t 161 U /^ Drinking fountain 25.02
✓I tl Ejectors sump 25.02
»; TENANT Expansion tank 12.51
Name: v�� Fixture/sewercap 25.02
1 Fluor drain;floor sink'hub 25.02
Address: 0 5 Garbage disposal 25.02
City/State/ZIP: r7 Hose bib 25.02
Phone: ) 6210 - Fax:( ) Ice maker 12.51
'( �y,y r >"'Y 'm Interc toe n'ease trap
25113
. .3a ,.f' "`'drGONTACT'pERSUN eP 6 P
Business name: Medical gas(value S ) Page 2
Contact name:
Primer 12,51
!S (�'x R(utfdrain(commercial) 12.51
Address: Sink basin[a,story 25.02 50.0
City/Slate/ZIP: Solar units(p(table water) 62.54
Phone:( ) Fax: :( ) Tub shower shower pan 1251 Z5_.D7.
E-mail: Urinal 25.02
_
Water closet 25,02 S.DJ,
' /�.` ater heater 37.52
Business name: �`J"r�FN (y f-1
pipingiDW V 56.29
Address: //(gyp d�h, i A\jE (O( Other: 25.02
City/State/ZIP:
Phone:(�' o ('(L Subtotal (x•04
L 1 Fax: Minimum permit ice 572.50 _�
f ( 1
CCB Lic.: '(it 3 Plumbing Lic. no.: 3�' �/�U Plan review (25'.,,t permit fee)
perfee)
State suichurge(120,a ofpennit fee) /$
Authorized signature: TOTAL PERMIT FEE
Print name: Date: j This permit application expires if a permit is nut obtained within IRU tars
/� after it has been accepted as romplete.
'Fcc ns0todology set by in-('aunty Building Industry Service Board.
1.Building Permits Pl V r-PermioxPPdoc to of uo 440-4P 16I f I U 02 CONI Is I3B1
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
gi ate. Fce(a) Tail Foofs ace t.Fees
Footing drain-I"100' 50.03 0(o 2,000 $121 90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $16269
3.601 to 7,200 $233.20
Sewer-I st 100' 62.54 7,201 and greater 5327.54
Sewer-each additional 100' 37.52
Water Service- 1s1100 62.54 Medical Gas .S stems:
Water Service-each additional 100' 37.52
Storm&Rain Drain- I st 100 62.54 '
$1.00 to$5.000.00 Minimum lee$72.50
Stonn&Rain Drain-each additional 100' 3252 55.00 LOO to 510,000.00 572.50 for the first 55.000.00 and$1.52 for
16ller11---l—r-1OIIE pr'#'-' 1 �Y' f - each additional$100,00 or fracliun thereof,to
ftqwlliand including SI0,000.00.
Inspection otexisting plumbing or for 510.001 00 to 525.11011.00 5148.50 for the first S 10.000.00 and S1954 for
which no fee is specifically indicated 90,00 In each additional 5100.00 or fraction thereof,to
(minimum char e— 1/2 hour) and including$25,01111.80.
Inspections outside of normal business 90.00/hr $25A01 00 to$50.(10(1.00 5379.50 f+r the first$25,000.00 and$1.45 for
(tours(mininwm charge—2 hours) each additional Sl 00.00 or fraction thereof.to
Reinspection Fees 90.00 lir and including 550,00(111(1.
Additional plan review for revisions 90.00111 550,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge— 1'2 hour) each additional$10000 or fiaction 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*. PianRevieW for Plumbing IhS}flllAtiOliS
nt ly by Fixture Type— Plan review is required for any of the following.
Fixture Type for Replwe/ Please check all that a 1
Work Performed: Capped Added Relocate ppy'
E]Baptistry-Font Any new commercial building with water service 2-'and
greater,except systems designed and stamped by licensed
Bath: -Tub Shower
-Jacuzzi/Whirlpool engineer.
Car Wash_ -Faeh Stall ❑ New exterior plumbing site utilities for any complex structure
Dnvc Thou as defined in 0AR918-780-0040.
Cuspidor Water As irawr ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose tiro sprinkler system.
-Domestic ❑ Any complex structure as defined in 0AR918-780-0040.
Drinking Fountain
Fye Wash Submit 2 sets of plans with any of the above.
Floor Drain sink: -2
Isomehic or Riser-Diol-ram
-4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-fond that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
lee Mach.Refri .Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink: -1-av/Bar non-food related
-Bradley
-Coni Sen Util food related
-Sct'vice *Note: If the fixture work under this permit results in an
S"inurring Rw1 FAter increase of sewer EDUs,a sewer permit will be issued and
Washer es
Wutcr Extractxtraco p
fees assessed for the sewer increase must be aid before the
or
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I: Building'Pennits�PLMF—PcnnitApp.doc 0841412011 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
12102 SW WILDWOOD ST, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00009
Don Sylvester
Violation Summary:
Inspector Contractor