Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00055
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 02/23/2017
TfC.r1I<.f.) 9
Parcel: 2S101 DC04900
Jurisdiction: Tigard
Site address: 13400 SW 76TH AVE
Project: WILSON Subdivision: PACIFIC RIDGE Lot: 1
Project Description: Repiping home and 100 ft.of water service.
Contractor: TRUE BLUE PLUMBING LLC Owner: WILSON, CHRISTOPHER E&
3300 NW 185TH AVE#311 SHARON K
PORTLAND, OR 97229 13400 SW 76TH AVE
TIGARD, OR 97223
PHONE: 503-747-9989 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Water Service 02/23/2017 $62.54
Specifics: 1 ea Water Piping/DWV 02/23/2017 $56.29
1 12%State Surcharge- 02/23/2017 $14.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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 otification enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or rect questions to • NC by calling 503.232.1987 or 1.800.332.2344.
I sued By: k // , Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available in a ion 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 . hole ohhi(l: I sI: o'LI'
City of Tigard > N 4 ss Received Permit No.:
13125 SW Hall Blvd.,Tigard,O�t9 _. Date/By: 02/e/3)/02/e/3)/ + '�- �"[/�
!'`� a T ;1v j�-
■ Phone: 503.718.2439 Fax: 5 598.1960lig Plan Review Other Permit No.: ,t yt /
Date/By: i yy�l �15 `et nti/
Inspection Line: 503.639.4175 °� \1
T 1 G A R D ;, 4 1 Date Ready/By: Juris: gi See Page 2 for
Internet: www.tigard-or.gov i�. .- kat) Notified/Method: - Supplemental Information
TYPE OF WORT I`A 1 FEE* SCHEDULE
„:_ti::‘ t
0 New construction }�en4gl!trt)‘°,` ` For special information use checklist
,ter ill j Description I Qty. Ea. Total
Addition/alteration/replacementer: New 1-2-family dwellings(includes 100 ft.for each utility connection)
' \ CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
jiLl-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 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 "; ,/ C'. / � - Catch basin or area drain 18.76
City/State/ZIP: ' rl . ( i '7 Drywell,leach line,or trench drain 18.76
t'. 1 �.
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: J, r�'Cl Manufactured home utilities 50.03
Cross street/directions to job site: �'V 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.: t 1 Page 2 Colt ii
Subdivision: [Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
R i`i - t 1.C (i t &r t d't tt >C` Dishwasher 25.02
.t" °t"-'l.i LA)L1,, (' '143, j z 1 t-re>t`l i i,4 e Drinking fountain 25.02
1,* g
c Lel 1\ l C i< y 3(;1. fcL(r .+,s j - i7.34=-c-.,_ Ejectors/sump 25.02
0 PROPERTY.OWNER l 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: �,1F)s't�,n 1. p,^ 1,0 } 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
---7. )7 Medical gas(value:$ ) Page 2
Business name:
�;�A1',ttaic.,: l (�-tft"(I/ i ti '
-7 Primer 12.51
Contact name:
t.--' ` pt i c'I ,. I r' >1 Roof drain(commercial) 12.51
Address:
L .:,1.. 140. ' //^ ki e ` �.4't f Sink/basin/lavatory 25.02
City/State/ZIP: rpt\ cf 1 r l Ylt. C \ •2. 2, ; Solar units(potable water) 62.54
Phone:(ht,,.4 7s 7- 1 -` Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: ,.
. c--=-' Waterpiping/DWV 56.29 �` l
Address: -..7 / . gf 1 1 Other: 25.02
City/State/ZIP: Subtotal //3.
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: i `]" ? e,;1 ', Plumbing Lic.no.: �/? Z f-t Plan review (25%of permit fee)
,r State surcharge(12%of permit fee) ,//1.)-0
Authorized signature: " ''= TOTAL PERMIT FEE,/33.J<
�--�-. �' ,-� '"'� ) _ _.i This permit application expires if a permit is not obtained within 180 days
Print name: '1 / o- (1e-44/ Date: 2. 2 �,a 7
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(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-1st 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' r 62.54 42 Stt Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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 Fee each additional$100.00 or fraction thereof,to
p Qty. (ea) Total
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the fust$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
0 Any new commercial building with water service 2"and
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
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
13400 SW 76TH AVE, TIGARD, OR, 97223
Record Type:
Residential - Plumbing
Inspection Type:
399 Plumbing final
Result:
PASS- NoCofO
Comments:
Tel: 503.718.2439
Inspection Date:
Record ID:
PLM2017-00055
Inspector:
Don Sylvester
1. Water line repipe - ok
2. Note: verify proper grounding of electrical system is in place when plastic materials
replace metallic water service . Per sec. OPSC 604.8.
Violation Summary:
Inspector Contractor