Permit (238) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00636
T[C a'1 R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/29/2016
Parcel: 2S 111 AD04300
Jurisdiction: Tigard
Site address: 8995 SW PINEBROOK ST
Project: Esmond Subdivision: PINEBROOK TERRACE Lot: 40
Project Description: Relocating clothes washer,bathroom sink&shower stall.
Contractor: WATER CENTS LLC Owner: ESMOND,VIRGINIA A
2110 NW 379TH ST 8995 SW PINEBROOK DR
LA CENTER,WA 98629 TIGARD, OR 97223
PHONE: 360-975-8575 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 12/29/2016 $25.02
Specifics: 1 ea Lavatories 12/29/2016 $25.02
1 ea Tub/Shower/Shower Pan 12/29/2016 $12.51
Type of Use: SF 10 Minimum Fee Adjustment- 12/29/2016 $9.95
Class of Work: ALT Plumbing
Type of Const: g 12%State Surcharge- 12/29/2016 $8.70
Occupancy Grp: Plumbing
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. .-: Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if wo is not sta ed within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to fo .w the rules al opted by the Oregon
Utility Noti#rcation ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtai a copy of the rules
or d' questions to O C by calling 503.232.1987 or 1.800.332.2344.
ssued By: Permittee Signature: / A
,
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 RECEIVED Received FOR OFFICE 1 SE ONE.)'
City of Tigard Date/By: / o?9 gii
o' / Permit No.: tOjjllo'"DOa
im IN 13125 SW Hall Blvd.,Tigard,OR 9 9 2016 7
_ Plan Review
Phone: 503.718.2439 Fax: 503.50,8.4460" Date/By: Other Permit No.:
Inspection Line: 503.639.4175
T I G A R D g g OF I v o AHD Date Ready/By: Juris: gi See Page 2 for
Internet: www.ti and-or. ov CITY Notified/Method: Supplemental Information
TYPE O i" c) v u)E'�' -
FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description Qty. I Ea.pAAddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
Pte.-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB Sff.K INFORMATION AND LOCATION. Site utilities:
Job site address: 8C( \' S u \P v h ro� 5-i- Catch basin or area drain 18.76
City/State/ZIP:
Drywell,leach line,or trench drain 18.76
�
i Footing drain(no.linear ft.: ) Page 2
G
Suite/bldg./apt.no.: I Project name: 1. NT:23Manufactured 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
DESCRIPTION OF WORK. sw Backwater valve 12.51
(� ( .q��=' ' ''- Clothes washer J 25.02
-{ '.4`of ""6 r 4.. Dishwasher 25.02
-13 )q-1,4,, D07 71 v <... Drinking fountain 25.02
Ejectors/sump 25.02
1;,1PROPERTYoWNER _ y ❑ T iANT < Expansion 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
APPLJCANT' CO ACT PEON Interceptor/grease trap 25.02
Business name: t ' ) (k C A.4.5 Medical gas(value:$ ) Page 2
Wq�� Primer 12.51
Contact name: ► w i t le-Q L.Q--c_.
Roof drain(commercial) 12.51
Address: 2_1 v C) (ALA, ''' - c`{^ SA-. Sink/basin/lavatory 1 25.02
City/State/ZIP: L ►("."-'r2 k.AJ isk 610 CiriVir Solar units(potable water) 62.54
Phone:(''(X)) 0 S as-4s- Fax::( ) Tub/shower/shower pan 12.51
E-mail: i' l(4e to W ODIC r C a n S _ a Urinal 25.02
CONTRACTOR Water closet 25.02
` Water heater 37.52
Business name:
Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) /_/ Fax:( ) Minimum permit fee: $72.50 7O9'5 t'
CCB Lic.: 1 9 V 3 3 IB j('7 I g Plumbing Lic.no.: cr4,9,6-". Plan review (25%of permit fee)
Authorized signature: 135 t a t Co. 7//lt7 State surcharge(12%of permit fee) g 7�
TOTAL PERMIT FEE g,c 2
Print name: 'cc\\Vg., \,,,,„e„.„( Date:\L Z.,,cC ,,,Co 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-PemiltApp.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 Qtr. Fee(ea) Total Square Footage: Permit Fee:
Footing drain 151 100' 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 $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
Other Inspections or Fees
Qty Fee� � Total each additional$100.00 or fraction thereof,to
pand 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*. Plait ReviCW for Plumbing Ingrallations
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 engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
-Commercial
al 0 Any multipurpose fire sprinkler system.
Dishwasher:
Domestic 0 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" Isome ric or Riser:Diagram
4" ❑4 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/Sery/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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8995 SW PINEBROOK ST, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2016-00636
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Note: caulk around base of water closet.
Violation Summary:
Inspector Contractor