Permit (132) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00036
13125 SW Hall Blvd.,Ti Date Issued: 02/06/2017
Ttt �'1Fs. and OR 97223 503.718.2439 9
Parcel: 2S103BD11800
Jurisdiction: Tigard
Site address: 12610 SW 121ST AVE
Project: Nix Subdivision: 2008-056 PARTITION PLAT Lot: 2
Project Description: (1)kitchen sink for upstairs plumbing,and adding(1)water heater for a total of(2)water heaters. Per Inspection
notes for MST2016-00216,new permit and inspections are required to finish upstairs plumbing.
Contractor: NORTH STAR PLUMBING INC Owner: NIX, DAVID C
21110 SW CHAPMAN RD NIX, JULIA A
SHERWOOD, OR 97140 12630 SW 121ST AVE
TIGARD, OR 97223
PHONE: 503-625-2679 PHONE: 503 314-0798
FAX: (503)625-4567
FEES
Quantity Description Date Amount
1 ea Sink 02/06/2017 $25.02
Specifics: 1 12%State Surcharge- 02/06/2017 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 02/06/2017 $9.96
Class of Work: ALT Plumbing
1 ea Water Heater 02/06/2017 $37.52
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 questions to OUNC by calling 503.232.1987 or 1 : .- . 14.
Issued By: Air . 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 Application
Building Fixtures VIN l FOR OFFICE I SE ONLv It'V
City of Tigard Received Permit No.: t 1
II 13125 SW Hall Blvd.,Tigard,OR 97223 { Date/By: 92/C,�/7 � � )R L/7_-ii i (:,
\��>( Plan Review III
0` Phone: 503.718.2439 Fax: 503.598.1960 r- ' - Other Permit No.:
Inspection Line: 503.639.4175 r Date/By: MJj (�16' ��
4 I G A R D a- Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov rI I Po Notified/Method: Supplemental Information
TYPE OF WORK is I5tO FEE* SCHEDULE
New construction 0 LtelllitiP 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
0 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: /, ,‘10 �� / �_7( / Catch basin or area drain 18.76
v/ Drywell,leach line,or trench drain 18.76
City/State/ZIP: --7-5°5r �j"-- Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: / I Project name: s'e- PV. Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
e/tg>‘J� 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
DESCRH!tION OF WOIt $"£. Backwater valve 12.51
(;) t_ Clothes washer 25.02
Ci Clk.rir- � r .,-/ J, 'kr t o 1e+a�c Dishwasher 25.02
�11 Ly,,,o,yV/ Drinking fountain 25.02
r / Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: /Q(,.,,,/ ( Fixture/sewer cap 25.02
�y�f�C1� Floor drain/floor sink/hub 25.02
Address:
S>9, f Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
ij APPLICAN 0 CONTACT' PERSON Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: /�,_c..- 7- . ._
Roof drain(commercial) 12.51
Address: � k• Sink/basin/lavatory / 25.02 M. '„)..
City/State/ZIP:`c1���,+ Solar units(potable water) 62.54
Phone:(C -7 `sZ_.2 s--7 Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
.. Water closet 25.02
CONTRACTOR Water heater 37.52
� �/ _ / '�v�s
Business name: "Y/���5T�v �/ ...,�,1i/J5 Waterpiping/DWV 56.29
Address: 21 I/0 S (/1`27) '' ✓ Other: 25.02
City/State/ZIP: 3- .sc.,J .i iiie
`j 7/IL/ Subtotal
Minimum permit fee: $72.50
Phone:(52.3) t'.)A i,, .7 C/ Fax:( ) . ....Z,)
CCB Lic.: t(i ��I� Plumbing Lic.no.: 3:"....p?�j
Plan review (25%of permit fee)
e5State surcharge(12%of permit fee) , 70
Authorized signature: ("./j/ TOTAL PERMIT FEE
/ ys
Print name: / / Date:/2 -/jZ This permit application expires if a permit is not obtained wit to 80 Gays
Xafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:ABuilding\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 Suppression Systems:
Site Utilities Qty. 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 Qt.' Fee(ea) Total each additional$100.00 or fraction thereof,to
h 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 Review 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 ❑ Any new commercial building with water service 2"and
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: -EachStall
as defined in OAR918-780-0040.
-Drive Tani
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
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" Isometric or Riser Diagram
4„
0 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:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
.€ 3 �€t :.t
124,
399 Plumbing final 01/31/2017 FAIL Aaron Cillo-Gobel Date: 1/31/2017
Provide caulking around laundry sink. Provide
sink clips for underside of laundry sink.
Master water closet not flushing.
Provide caulking at shower 90 for hand held
master shower.
Provide caulking/grout around hall bath tub.
Hot and cold crossed at hall bath tub.
Provide insulation on exposed water lines in
garage.
Seal and secure hot and cold hose bibs right side
of garage and all other exterior hose bibs.
Exterior clean outs need to be glued in place and
brought down to grade.
399 Plumbing final 02/01/2017 PASS Don Sylvester Date:2/1/2017
1. Corrections are complete-plumbing final
approved.
2. Note: up stairs living space is for plumbing
rough-only, new permits and inspections will be
required in order to finish.
199 Electrical final 02/02/2017 PASS David Young Date:2/2/2017
Provide breakerlock for kitchen dishwasher not
plug and cord connected.422.30
Will check at building final inspection.
Provide permit for heat pump connected without
permit.
Separate electrical permit for mini split required.
No hot tub installed at this time.
699 Mechanical final 02/02/2017 PASS David Young Date:2/2/2017
Provide new permit for mini split installed without
permit at bonus room.
Provide permit for microwave venting in bonus
room.
Mechanical final for house only ok.
Page 4 of 5
CaseActivityShortForm.rpt
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12610 SW 121 STAVE, TIGARD, OR, 97223
Record Type:
Residential - Plumbing
Inspection Type:
399 Plumbing final
Result:
PASS- NoCofO
Comments:
1. Plumbing final for upstairs apt. - approved
Violation Summary:
Tel: 503.718.2439
Inspection Date:
Record ID:
PLM2017-00036
Inspector:
Don Sylvester
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12610 SW 121 STAVE, TIGARD, OR, 97223
Record Type:
Residential - Plumbing
Inspection Type:
399 Plumbing final
Result:
PASS- NoCofO
Comments:
1. Plumbing final for upstairs apt. - approved
Violation Summary:
Tel: 503.718.2439
Inspection Date:
Record ID:
PLM2017-00036
Inspector:
Don Sylvester
Inspector Contractor