Permit (83) a CITY OF TIGARD PLUMBING PERMIT
IICOMMUNITY DEVELOPMENT Permit#: PLM2016-00170
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2016
TIGARD Parcel: 2S104AC09400
Jurisdiction: Tigard
Site address: 13234 SW BOUNEFF ST
Project: Thomas Subdivision: MORNING HILL NO.9 Lot: 237
Project Description: Relocate washer and water heater.
Contractor: TRITON PLUMBING&MECHANICAL Owner: THOMAS, BRIAN D& KATHLEEN M B
P.O. BOX 1904 13234 SW BOUNEFF ST
WOODLAND,WA 98674 TIGARD, OR 97223
PHONE: 360-740-7701 PHONE:
FAX: 360-573-2041
FEES
Quantity Description Date Amount
1 ea Clothes Washer 03/31/2016 $25.02
Specifics: 1 ea Water Heater 03/31/2016 $37.52
1 12%State Surcharge- 03/31/2016 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 03/31/2016 $9.96
Plumbing
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 the rules
or direct qu o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B : Q/C‘Ct't41
Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspec'- 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 RECEIVE . FOIR OFFICE FS t: 01I.\
Received u
City of Tigard �� 1/ Permit No.: , 17,9,0/4,_-ex,/70
.114 U 13125 SW Hall Blvd.,Tigard,O r9
Date/By:v Y�
II
7 16 Plan Review
Phone: 503.718.2439 Fax: 5 3.598. . 64 ' 'I Other Permit No.
Date/By: 1`157d'1J45 qalo 2�
Inspection Line: 503.639.4175 Date Read /B Juris. ® See Page 2 for
i I(.:AKI) q Ready/By:
Internet: www.tigard-or.gov ( t' 1y 1,1(0 Notified/Method: Supplemental Information
,a,. , _ _,,_ _ -,sit<.As. ',,A.P ,-Ci :ziL ff°'wr .. °: _��7 s � i s. ;:i s i,,„,-,4410,4164,1A.:14',: ;,4. ,. a! -,,,,.+'.,"',
❑New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. i Total
.B/Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
AMY , , dr ,,t 't,'„,;,,.!1: i". R1 r 14 ' : 4. l t SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family •
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
ar a •
c y(^ t . -,,,,r, ri Site utilities.
��� ,�".$�t� �;. „..4„.4._,,,,,,_„5,„
"'.z," zC6^�oto, �M tusxe�ta5 d9T �li9�, � �:,+ r� .�k... ."+�.a= ia�" „-�,t�c.o.
Job site address: ' 21).-3 41 .9(Ai 1Q oprobe Catch basin or area drain 18.76
City/State/ZIP: -�`) &,-� ,/� Drywell,leach line,or trench drain 18.76
R 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
4 � 7,2,7431,7470.7517.7„7,7: ac water valve 12.51
... ..4, - - r� �a•. s:�, -...,.,_. .,,. •, . r,* . 7: Clothes washer 1. 25.02
M Wa`��IetDishwasher 25.02
4 -40144g w4 it't- I p Drinking fountain 25.02
1" M 01 Q` • 22 .. Strj , • - Ejectors/sump 25.02
pr jar ..?". ffi _ft. 4 s'. ' * r, m $f 3+pV'b 1p k t 1 r l� 6
s i, § �\ 6 PY` ., Expansion tank 12.51
Name: v Fixture/sewer cap 25.02
6'''7..4`&- 41A4 k11/1,127146-A Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
; r � : I ,,, Interceptor/grease trap 25.02
Business name: ,A---kw--- (e-►'LSL/ Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: k/��h Roof drain(commercial) 12.51
Address: 20/14 D 5W yu-1(1cg /
Sink/basin/lavatory 25.02
City/State/ZIP: Al v f.,-4 7 ?ty3 b Solar units(potable water) 62.54
Phone: ), --3/ eJJ ' ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: (-B r ---' A 4' 1 / C C Urinal 25.02
x i [y^ 4<,, , w y r mss, Water closet 25.02
Water heater 37.52
Business name: T.rl Pu ll Water piping/DWV 56.29
Address: /9 0 6o4, l�U 4 /LA/4, itokA Other: 25.02
City/State/ZIP: V At a Q 6 Subtotal � i
1 vv Minimum permit fee: $72.50 .Sr-/
Phone:( ) Fax:( )
r Plan review (25%of permit fee)
CCB Lic.: 14 1 4 Al Plumbing Lic.no.: 2'J 5b_ ?e, State surcharge(12%of permit fee) �Zt7
Authorized signature: TOTAL PERMIT FEEav
Print name: fi
R Nom_, Date: �/3 j l This permit application expires if a permit is not obtained within r8�days
after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry Service Board.
1:Building Permits PLMU-PermitApp.doc 10 01 09 440-4616T(10 02 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su s i ression S stems:
u av< d 7, (1 ,c itil `7,r../5'J ¢ f "A M , j
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
,✓ ^>,sa� x,y4.,do . AO. 3 x d. t..F`w� ."'. « '.
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
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 chane 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*. ntin RevjIW,foi Plumb g; lasts& i+l#ns
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
-Jacuzzi/Whirlpool engineer.
I:Car Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
ElCuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 111 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"
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
plumbing permit can be issued.
Water Closet-Toilet P g P
Urinal
Other Fixtures:
1:ABuilding\Pernits\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
13234 SW BOUNEFF ST, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00170
Chip Barnett
Violation Summary:
Inspector Contractor