Permit (69) k.
CITY OF TIGARD PLUMBING PERMIT
j ¢ Permit#: PLM2016-00470
COMMUNITY DEVELOPMENT �'
.y Date Issued: 09/12/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 25111 BA06800
Jurisdiction: Tigard
Site address: 9541 SW INEZ ST
Project: Ban Subdivision: BUTLER TERRACE Lot: 2
Project Description: Underslab piping only. Fixtures to be set later under separate permit.8/21/17 REPRINT to add(1)clothes washer,
(7)lays,(7)toilets,(4)showers&water supply for(1)tankless water heater.
Contractor: JCB CONSTRUCTION&PLUMBING LLC Owner: BAN, MIRCEA&DIANA
240 NE 19TH ST 9541 SW INEZ ST
GRESHAM, OR 97030 TIGARD, OR 97224
PHONE: 503-358-5515 PHONE: 425-919-2705
FAX:
FEES
Quantity Description Date Amount
2 ea Water Piping/DWV 09/12/2016 $112.58
Specifics: 1 12%State Surcharge- 09/12/2016 $13.51
Plumbing
1 ea Clothes Washer 08/21/2017 $25.02
Type of Use: SF
Class of Work: ALT 7 ea Lavatories 08/21/2017 $175.14
Type of Const: 4 ea Tub/Shower/Shower Pan 08/21/2017 $50.04
Occupancy Grp: 7 ea Water Closet 08/21/2017 $175.14
Stories: 1 ea Water Heater 08/21/2017 $37.52
0 12%State Surcharge- 08/21/2017 $55.54
Plumbing
Total $644.49
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 Notific i Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may i btain a copy of the rules
or direct estions to NC b calling 503.232.1987 or 1.800.332.2344. r
Issued y: / Permittee Signature: 14
-44111''�
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 pro ect.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applic t9pIA JNI 11f19
Building Fixtures OHVOl... JO A.1.10 FOR OFFICE USE ONE
Received I Permit No.: -co 7 7O
III City of Tigard Li Oe c�n� y b� It,tio2O!
U 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B
■ Plan Review Other Permit No.:
Phone: 503.718.2439 Fax: 5 . 9,�0I Date/By:
Inspection Line: 503.639.4175 !!�� 3' j Date Ready/By: Juris: H See Page 2 for
T I C A R D Internet: www.ti and-or. ov s
g g Notified/Method: Supplemental Information
w TYPE'OF WORK : FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION ,;„-- :` 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
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
. JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 5y/ s-u) ,N e. •-r Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I 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
�.,,. A,` Backwater valve 12.51
„',`, DESCRIPTION OF WORK` r3 = `
- - Clothes washer / 25.02 ,t4.07-
4-Ty� -ro x/5 Ti ( I'f 2 / Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PRO* OWNER .` 0 TENANTExpansion tank 12.51
Name: Fixture/sewer cap 25.02
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
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 7 25.02 J7'5lt/
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan /� 12.51 45-0.04
E-mail: Urinal ( 25.02
k Water closet / 25.02 /75,i 1F
CONTRACTOR
�nJ �/1 Water heater / 37.52 37.57--
Business name: �► 6 L,g-r-e 'rj0 z a /(-Llt,�1r� Water piping/DW V 56.29
Address: Other: 25.02
City/State/ZIP:
Subtotal ylo(2.'t )
Phone:( ) / Fax:( ) Minimum permit fee: $72.50
CCB Lic.: I Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) 55\511
Authorized signature: j TOTAL PERMIT FEE 57 g,q6
Print name: SVA i'�1 c..L ,,4-/ Date: 1(/91 1/7 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 10/01/09 440-4616T00/02/COM/WEB)
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 s`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
Valuation; Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $100 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
w,, each additional$100.00 or fraction thereof,to
(ether Inspee * ..s or Fees pee(ea) Total 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 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*. Plan Reiew 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
0 Any new commercial building with water service 2"and
Baptistry/Font
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
hm
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any 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 xw.
4
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
1111 CITY OF TIGARD PLUMBING PERMIT
1r,
COMMUNITY DEVELOPMENT Permit#: PLM2016-00470
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/12/2016
Parcel: 2S111BA06800
Jurisdiction: Tigard
Site address: 9541 SW INEZ ST
Project: Ban Subdivision: BUTLER TERRACE Lot: 2
Project Description: Underslab piping only. Fixtures to be set later under separate permit.
Contractor: JCB CONSTRUCTION&PLUMBING LLC Owner: BAN, MIRCEA&DIANA
240 NE 19TH ST 9541 SW INEZ ST
GRESHAM, OR 97030 TIGARD, OR 97224
PHONE: 503-358-5515 PHONE: 425-919-2705
FAX:
FEES
Quantity Description Date Amount
2 ea Water Piping/DWV 09/12/2016 $112.58
Specifics: 1 12%State Surcharge- 09/12/2016 $13.51
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $126.09
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 qu: ons to..NC by calling 503.232.1987 or 1.800.332.2344.
Issued :y: , 0Permittee Signature: �',1//
62--,11Aci L/ IMIllir
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 th project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicatjon '
Building Fixtures
FOR OFFICE LSE ()NLN
'r p
J .,
City of Tigard Received Q ^, I/- //
1,1 13125 SW Hall Blvd.,Tigard,OR 97223
''' Date/By: / �a- //p (D2/22
PermitNo.: �L�OYJ!IP'� T ��
■' Phone: 503.718.2439 Fax 503.598.1364 Plan Review
Date/By: Other Permit No.:1�fyT3oi•�'�l�?
T I G A R D Inspection Line: 503.63q, 75,` Date Ready/By: Ju is: ® See Pa
Internet: www.tigard-or.gov ' ',' 1gefor
Notified/Method: Supplemental Information
TYPE OF WORK
FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description
❑Addition/alteration/replacement 0 Other: Qt3I Ea. I Total
for I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
o 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
o Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND. LOCATION
Site utilities:
C _Pi 4 '` ICatch basin or area drain
18.76
Job site address:
City/State/ZIP: ) C A-P t., GQ, ` 9 7 2-a4
Drywell,leach line,or trench drain 18.76
/ '^(� Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: /V)/iZC E4 ff.()LI y
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear fttj Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear$.- Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve
DESCRIPTIGN OF WORK " 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Cl,PROPERTY OWNER
❑'TENANT Expansion tank 12.51
Name: f v1,��i2 C€4 /. 11/41 Fixture/sewer cap L 25.02
Address: C)j):1 g W e_2 <1- Floor drain/floor sink/hub ` 25.02
ty ` P(-2.,4-i 6 0j- 9 7 Garbage disposal / \ 25.02
Ci /State/ZIP: n
Hose bib
Phone:(A�.�) 1 oi 27n S Fax:( ) Ice maker �� h 25.02
12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap ` 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal c
25.02
CONTRACTOR Water closet 25.02
Business name: 7 6 CONSi i'�itC.l/O// d"Oji-(�( 8�(NC LL .. Water heater _ 37.52
Water piping/DW V ,� 56.29 /42.51
Address: tf0 NE lc7 ' sr:,� .
Other: 25.02
City/State/ZIP: Cr�E 5 A=-71 / 0 k , / C7 7® 0 Subtotal /./A.S g
Phone:(SO Ij) l _ l �l
j r/S Fax:( ) .1\
Minimum permit fee: $72.50 '
CCB Lic.: 209 f,i 7 0 /!8 Plumbing Lic.no.:lb iG 6 8 „i111 �^
Plan review (25%of permit fee)
t State surcharge(12%of permit fee) /3.S"/
Authorized signature: r,
TOTAL PERMIT FEE /A6,0?
Print name: iii1 Date: D / (�1z /f 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-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities �. Fee(en) Total Square Footage: Permit Fee:
Footing drain-l'100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 Valuation: Permit Fee'
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 fust$5,000.00 and$1.52 for
) A �b tal
each additional$100.00 or fraction thereof,to
Other Inspections or Fees and including$10,000.00.
Inspection of existing plumbing or for $10001.00 to$2000.00 $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.
Additionalplan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 Plumbingnstalltions
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 ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3" isometric orRiser Diagram
-4" 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains
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
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2