Permit (53) � ,� CITY OF TIGARD PLUMBING PERMIT
2' COMMUNITY DEVELOPMENT Permit#: PLM2016 00152
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23/2016
Parcel: 2S103BB11700
Jurisdiction: Tigard
Site address: 12160 SW ANN PL
Project: Travis Subdivision: YE-OLDE WINDMILL Lot: 36
Project Description: Update master bath:(2)lays,(1)tub,(1)shower&(1)water closet.
Contractor: KTP PLUMBING CO Owner: TRAVIS, CRAIG B&TANAE
6663 SW BEAVERTON-HILLSDALE HWY 12160 SW ANN PL
PORTLAND, OR 97225 TIGARD, OR 97223
PHONE: 406-544-6750
HONE: 503-869-8776
FAX:
FEES
Quantity Description Date Amount
2 ea Lavatories 03/23/2016 $50.04
Specifics: 2 ea Tub/Shower/Shower Pan 03/23/2016 $25.02
1 ea Water Closet 03/23/2016 $25.02
Type of Use: SF 1 12%State Surcharge- 03/23/2016 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued BC • Permittee Signature: ' /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicata l F
Building Fixtures
�CFIVEP
2 . Received q �3 1 �H(9_0/ ��
City of Tigard r l. o.? Permit No.:
13125 SW Hall Blvd.,Tigard,OR 9722'`'' . 0 ' F Date/By:
I
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960III
Date/By: Other Permit No.:
Inspection Line: 503.639.4175 y t t- y tkiAkat+
1 I l i:\R D i 1 l i Date Ready/By: Jur s: ® See Page 2 for
Internet: www.tigard-or.gov "r ,it a L. Notified/Method: Supplemental Information
f-;c g, .,"` a,E '!"' - - ''"t +F:BE 44 P' r� c �` a'* g,t z.+s- ,-r- �E , �v e.e.._ `"td
£ .� °'Y a' i e d s 4r e 3 �r x f Z F, a e h , 1 a t L,� ,ra'.4A
;."h,; ,. d ��+.��� �;'.��.�'�:,�v � � �.�, 'y,&srka,,. '��,'i ��� ,,�L..s?�dyvr %�.'�.�� �!,';'.4.,.,w ° .�`° +�..z,,."i� �;5,�;nx f N ,..�-
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
a a . SFR(1)bath 312.70
"$ ---; �v�lt Yre".'�g>>..=s 9� du a'.eze,..�,� .9� ". s. . ;°S, =
f,1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
Wife
tMATIO 1`. LOCATION _ Site •utilities:
Job site address: I Z I (.o n 5 w an1J 'f'L Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: /TC O2 1 Z Z 3 , Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 12p Project name: #4,,,, ?L. Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
.�1
W A L_.J - / i->.W `PL 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 r 31.27
E�tIPTION OF`WORK Backwater valve 12.51
'D
Clothes washer 25.02
KC wt o 17L F'►'1 aSTE.c_ 3�'T'H_ Dishwasher 25.02
k---.....3=... ATT zC //d es tJ aJczi. Drinking fountain 25.02
Sep4 G e- Ejectors/sump 25.02
t` t ,,, I 'g e q Expansion tank 12.51
m.
Fixture/sewer cap 25.02
Name: �q�� f,r-ca..,- Floor drain/floor sink/hub 25.02
Address: /Z /4 p S w ,e4,-)0 PL Garbage disposal 25.02
City/State/ZIP: 4467 O . q 72Z Hose bib 25.02
Phone:(966) 5C( - 7$Q Fax:( ) Ice maker 12.51
�.- --.. a .. . r � s Interceptor/grease trap 25.02
4N• L� �,te.4' �.. �. ,.41,-..,--zrat yt tia �a. ..„: %�-
-"rib dr - -` Medical gas(value:$ ) Page 2
Business name: - e- v . I� / _
Contact name:�f^ z Primer 12.51
/ LE'L Io t__ Roof drain(c.emmercyal) 12.51
Address: ?e, &a), 2' S/ �/ Sink/basi /lavato j 11 25.02 2
City/State/ZIP: Y Solar units(potable water) 62.54
/ SfJL4TTmx] else_ �I'7o� Z
Phone:(4/X) ) 3?Z _ sPz et Fax::( ) Tub/ owe sho er pan.) 12.51 ,
E-mail: r/(o�E G C L G� L- Urinal 25.02
a . a,. $/.i 8„ V.7*,,,,,.Axa g r. 'moi E vl ' g o � ')- ro
€ Water closet 25.02
,4•.:s` ,-...'$,:h ;,,c) P.1k , . 4d,43r. i. ,, s - t ,',.''k' , '� a:;7 )� Waterheater 37.52
Business name:
,Lc/M 0
t1
Water piping/DWV 56.29
Address: p� j `� J `�e t✓C/L/)/4/4 /6..„,/ 4,.,2-9,'
Other: 25.02
City/State/ZIP: PD� 5 7 ZZS Subtotal M6•og
Phone: v, 7 7(o 5 Fax:( ) Minimum permit fee: $72.50 ---
CCB Lic.: 7 - / Plumbing 3 y3 c //,g Plan review (25%of permit fee)
' Lic.no.: ! 7
State surcharge(12%of permit fee) /g:-el
Authorized sig yyW/Q TOTAL PERMIT FEE l/02,�
Print name:) ----' U(°.7 6( Date: p?-0)-' --/C. This 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 PLMU-PermitApp.doc 100109 440-4616T(1002 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su. s ression S stems:
};'
?�.....4 r.�:. .a Rear, .,...
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 S stems:
Water Service-each additional 100' 37.52 r *rr , E 6 f , !
LE �C� a.,�w„4 =,:nr -:„„ S i�^ _ A.' �a 1'..Mlw 616 ,
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
1TIK< � l _ 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 I/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*. . Jlan,Reje 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
111 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: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
C]Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
CIDishwasher: Commercial Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR9 1 8-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2'
El 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:
L:\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
12160 SW ANN PL, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00152
Don Sylvester
1. Correction complete - plumbing final approved.
Violation Summary:
Inspector Contractor