Permit (13) CITY OF TIGARD PLUMBING PERMIT
N..`° COMMUNITY DEVELOPMENT Permit#: PLM2017-00165
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/03/2017
Tt� 9 Parcel: 2S103DA07200
Jurisdiction: Tigard
Site address: 10900 SW MIRA CT
Project: PAPE Subdivision: MIRA PARK Lot: 10
Project Description: Replacing all existing water piping.
Contractor: TRUE BLUE PLUMBING LLC Owner: PAPE,ALAN R&JODI
3300 NW 185TH AVE#311 10900 SW MIRA CT
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503-747-9989 PHONE: 503-747-9989
FAX:
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 05/03/2017 $56.29
Specifics: 1 12%State Surcharge- 05/03/2017 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment- 05/03/2017 $16.21
Plumbing
Class of Work: ALT
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 obt ' a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ‘...4ree......./..... :1"-. 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 FOR OFFICE t sl oN1.1
City of Tigard
eceived
111 13125 SW Hall Blvd.,Tigard,OR 97223" ate/By: s`/3/I/7 �i - Permit No.:/9 ,i 7_,c01.6,5-
NEP Ian Review
C Phone: 503.718.2439 Fax: 503.598.19 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: Jnris:
-
TIG ARD ® See Page 2for
Internet: www.tigard-or.gov Notified/Method: SupplementalInformation
3 2017
TYPE OF WORK MAY FEE* SCHEDULE
ry� 66
0 New construction 0 De f�L>t� For special information use checklist.
' G D ll 1N V��4� t Description I Qty. Ea. Total
Addition/alteration/replacement 0 O New 1-2-family dwellings(includes 100 ft.for each utility connection)
j312.70
CATEGORY OF CONSTR TION- SFR(1)bath
k1-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:
Catch basin or area drain 18.76
Job site address: 10 900 ietii Alt f /�fa (i
a(� d q.7 2 Drywell,leach line,or trench drain 18.76
City/State/ZIP:
15 P ` J 2 3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 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:
Backflow preventer 31.27
Tax map/parcel no.: _
RES.,CR N 'ORRI T,,t, i,i Backwater valve 12.51
;w . ;:`..;_;.: : y , :..W O. r•.„ ,14,„5,-,,:/yt. . Clothes washer 25.02
"P ')Pe a it 0,3-her f 1't I S� T V Dishwasher 25.02
00611 F r x`}'C,vlse Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT*'" . Expansion tank 12.51
r A Name: A l e •. p.� Fixture/sewer cap 25.02
vy y. .4, /"i/
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
N 'APPLICANT 0 CON 4CF PERT " Interceptor/grease trap 25.02
Business name: "'�i'u c.„ f'11/Lei Pt C j k�l Medical gas(value:$ ) Page. 2
Contact name: / "'� PPrimer112.51
���Sd� �� Roof drain(commercial) 12.51
Address: 33 00 NG) l is'5 6 ,4-ve. 4E3 // Sink/basin/lavatory 25.02
City/State/ZIP: IN-hi-3k v1/ O t\ 7'72-2.9 Solar units(potable water) 62.54
Phone: 3) 7t---17 -'8'9- Fax::( ) Tub/shower/shower pan 12.51
r_ Urinal 25.02
E-mail: -(-1`.4,ti r G{F+�,x t Q yyl9�'<-Coq' Water closet 25.02
! CONTRA} CTOR =' `'
. .; ^ Water heater 37.52
Business name: C Waterpiping/DWV / 5629 5j.11
Address: Com' l j Other: 25.02
City/State/ZIP: Subtotal
Minimum permit fee: $72.50 -7,2..7�
Phone:( ) Fax:( )
CCB Lic.: 79 90 Plumbing Lic.no.: 2.572.57Plan review (25%of permit fee) --�
/
State surcharge(12%of permit fee) i ?(;
Authorized signature: TOTAL PERMIT FEE $/..,),e
Print name: 5 3,/' R ter Date: 3_(7 This permit application expires if a permit is not obtained within 180 days
�y 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 Fee(ea) Total Square Fotage: 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 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- (ea) TOS
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 Installailur.y
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
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-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.
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"
nitric or; iseraDiagram
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 beaid before the
Water Extractor p
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:
10900 SW MIRA CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2017-00165
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor