Permit (130) CITY OF TIGARD PLUMBING PERMIT
1111 3 ' COMMUNITY DEVELOPMENT Permit#: PLM2016 00129
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/09/2016
Parcel: 2S103BA00141
Jurisdiction: Tigard
Site address: 11965 SW LYNN ST
Project: DUTTON Subdivision: LERON HEIGHTS NO.2 Lot: 31
Project Description: Replacing all existing water piping in house.
Contractor: OWNER Owner: DUTTON, BRIAN & DEBRA
BRIAN DUTTON 11965 SW LYNN ST
11965 SW LYNN ST TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-572-7392 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 03/09/2016 $56.29
Specifics: 1 12%State Surcharge- 03/09/2016 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment- 03/09/2016 $16.21
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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of he rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. n
Issued By: 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.
Plumbing Permit Application
Building Fixtures ^ FOR UI•I I( 1: I SI: ONI.I
City of Tigard 4{.�/► Received /�'�'�DateBy: I '4/ / Permit No.: f �t t_ /Ady;� r 13125 SW Hall Blvd.,Tigazd,ORi3E.CelPlan Review [ L!� lPhone: 503.718.2439 Fax: 503. 960 9 2p�6 DateBy: Other Permit No. �, _/Lwc �
Inspection Line: 503.639.4175 l �
R Date Ready/By: Juris
nn ® See Pa e 2 for
IG;�R ) HS
I
Internet: www.tigard-or.gov * tilaid Notified/Method: Supplemental Information
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0 New construction B3y6 !' on For special information use checklist
Description I Qty. I Ea. I Total
7Adidttton/alteratton/repl acement 0 Othear
New 1-2-family dwellings(includes 100 ft.for each utility
y connection)
7 '+* e: S'f-;* '"1, ' a`-':4-'7':-"I'''!'. -x"." ,. Tre ?+, SFR(1)bath 1
' irw . . ..z»-;-..t .:;-/.1..A1,..,�. R ; zs ' ,.. s, � �' :
f�1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath
/❑Accessory building 0 Multi-family SFR(3)bath 437.78
00.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
,..,,,,,,,•::„,,,,.ti, .,. . ,,,,,:,..„42, ,, 1 4,,,,,A,," . ,:.1.4,:::-.,,,.'„12 ,, Site utilities:
Catch basin or area drain 18.76
Job site address: 1/9 G6' 4 yt,�,v .s•r
City/State/ZIP: -^ Drywell,leach line,or trench drain 18.76
i 6 6/2 6 9"'7 ZZ3 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 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 ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
-,-;`;1,7p,...,,44,;%414.4,
1 ' :r t a . + 1 r1 r M, &yhr
Backwater valve 12.51
` " k '"A e : 4✓ 3� 'e ° T
' Clothes washer 25.02
n .� • Dishwasher 25.02
(4C CJ(1f� L1,p, Drinking fountain 25.02
//f (� Ejectors/sump 25.02
�1
- Expansion tank 12.51
4! �'�;.k"`,v-, > 4,..:4.-1_, ar, a:"�`u.x, '--;..-::;'-if....'} &a. saat�a."":“V..5.,.:.0...,��' ,.::1$..
Name: Q Fixture/sewer cap 25.02
�r 1 Z�� Floor drain/floor sink/hub 25.02
Address: ji 56$ Shy `*i ')'� S'� --
xi" Garbage disposal 25.02
City/State/ZIP: .1<5,i t1L t7Q ti. f 7 ZZ 3 Hose bib 25.02
Phone:(;540.)) i?Z 7 9 Z Fax ( ) Ice maker 12.51
mrfroco
4 u Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
�RJ� Jk) Roof drain(commercial) 12.51
Address: /I 5'‘5' SpJ G I ANN Si Sink/basin/lavatory 25.02
City/State/ZIP: '7 G.ata O Igo.- q 71z3 Solar units(potable water) 62.54
Phone:(so3) 5) 2 '73c Z, Fax::( ) Tub/shower/shower pan 12.51
E-mail: R6 Q�s ..A ® .Coot
Urinal 25.02
"r' 14%!�`� d 1fs"' Water closet 25.02
Water heater 37.52
Business name: Water piping/DWV Y 56.29 • t
Address: Other: /` 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) --
State surcharge(12%of permit fee) $2,,70
Authorized signature: glietii--
f /!fv4 TOTAL PERMIT FEE 1�Print name: uuuu�3lll,,k) Date: 3 -5-j4 This permit application expires if a permit is not obtained within 180 days
�,� �Un after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
J
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su s ression S stems:
t rv; z �, �..v,- - �. t f .1:.'o-_`t ,.. .h.
Footing drain- 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
Water Service-each additional 100' 37.52 Medical Gas Systems:
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
each additional$100.00 or fraction thereof,to
11
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 char:e-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 char:e-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 char a 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 by Fixture Typo :7 ;,
Fixture Type for > �
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain;.. -z
Garbage Domestic-non-food 0 Isometric or riser diagram iserequired for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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