Permit (247) wiL CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2017-00001
TjGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/03/2017
Parcel: 2S103AD00100
Jurisdiction: Tigard
Site address: 10780 SW ERROL ST
Project: LINDBLOM Subdivision: ECHO HEIGHTS Lot: 15
Project Description: Bathroom remodel,(1)lay,(1)water closet,(1)tub/shower&(1)shower pan.
Contractor: EXPRESS PLUMBING Owner: LINDBLOM, RUSSELL J JR
1420 SE EASTWOOD CT STEPHANIE L
PORTLAND, OR 97222 10780 SW ERROL ST
TIGARD, OR 97223
PHONE: 503-380-6323 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 01/03/2017 $25.02
Specifics: 2 ea Tub/Shower/Shower Pan 01/03/2017 $25.02
1 ea Water Closet 01/03/2017 $25.02
Type of Use: SF 1 12%State Surcharge- 01/03/2017 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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
Utilit k : Center. ose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
• direct questions to oU' by c. • 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: � 4 / �f
\\ / Call 503.639.4175 by 7:00 a.m.for the next available inspection
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 REGFART.,
City of Tigard Received 1 L� l 7 �D/
III . 13125 SW Hall Blvd.,Tigard,OR 972134N V 3 2017
Plate/By: / e7 �7 Permit No.:
■ Phone: 503.718.2439 Fax: 503 98.1960 Plan Revie
Other Permit No.: d i ral v/�O9y b
Inspection Line: 503.639.4175 1661 " i Date Re �7 /*� (O JOY
TIGARD
0 �"twF�t � Date Ready/By: hair. 0 See page 2 for
Internet: www.tigard-or.gov BUILDING 8 - ;, Supplemental Information
y ,, , 'i t n,,t,„ Notified/Method:
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description Qty. I Ea. I 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
❑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 SITE INFORMATION AND LOCATION Site utilities:
Job site address:10780 S.W.ERROL ST. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD, OR 97223
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:WALNUNT&FONNER 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.:2S13AD-00100 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
BATH REMODEL
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:RUSSELL J.LINDBLOM Fixture/sewer cap 25.02
Address:10780 S.W.ERROL ST.
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:TIGARD, OR 97223 Hose bib 25.02
Phone:(503)639-5382 Fax:( ) Ice maker 12.51
)(APPLICANT g CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: 1_Y L SLS .j1�
Primer 12.51
1�' l �y.,�- Roof drain(commercial) 12.51
Address: �2?i lt^ ®� � ` /'�I V /�ll`"/ 3J'� Sink/basin/lavatory / 25.02 ��
City/State/ZIP: C cSAat..r-1 , r�l( 9 7v30 Solar units(potable water) 62.54 4,44'1 2--
Phone:(.5 3) Fax::( ) Tub/shower/shower pan 06 12.51
E-mail: Urinal 25.02
-
CONTRACTOR Water closet / 25.02 0 r�
Water heater 37.52
Business name:Z=`A , a �.�a if q . / Water piping/DWV 56.29
Address:4 12 0 f1y ,d/�,L t .1 x -l� C / , Other: 25.02
City/State/ZIP:11,1,i' Ci;y✓C ..l rt ie.1"{ 0 T�1 y `f - Subtotal 73,96,
Phone: 3) 11 z 3 •� FS ( ) / 2 Ll Minimum permit fee: $72.50
CCB Lic.:A t,6-6- !ci ill 1'1 Plumbing Lic.no.:1 2£3.r & Plan review (25%of permit fee)
a State surcharge(12%of permit fee) ,, Qp
Authorized signature: ru1�..
(/���.'^` TOTAL PERMIT FEE �[0.
Print name:fro N4 A r) �4 A, C(i Date:6 e is, L 4,_ 2v, permit application expires if a permit is not obtained within 180 days
J 'v after it has been accepted as wmplete.
*Fee methodology set by Tri-County Building Industry Service B d
I:iBuilding\PermitsiPLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COMJWEB) f 8 `�f�
1
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-1'100' 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
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty. Fee(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 futures? If"yes",
please indicate work performed by fixture. Failure to
accurately report futures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace! Plan review is required for anyof the following.
Performed: Capped Added Relocate 4
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 ❑ 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.
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required 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:
C:\Users\RUSSELL\Downloads\PLMF PermitApp.doc 2