Permit (33) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00204
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2017
Parcel: 2S 109BA00500
Jurisdiction: Tigard
Site address: 14169 SW 134TH DR
Project: Crowley Subdivision: THREE MOUNTAINS ESTATES Lot: 13
Project Description: Replacement of gas water heater with like kind.
Contractor: OWNER Owner: CROWLEY, ROSS R II &KIRSTEN E
ROSS CROWLEY 14169 SW 134TH DR
14169 SW 134TH DR TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-334-9969 PHONE: 503-334-9969
FAX: 14169 SW 134TH
FEES
Quantity Description Date Amount
1 ea Water Heater 05/23/2017 $37.52
Specifics: 1 12%State Surcharge- 05/23/2017 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment- 05/23/2017 $34.98
Class of Work: ALT Plumbing
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 N. • I. -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dirtt questions to 06 C . :fling 503.232.1987 or 1.800.332.2344.
Is ued By: /
R#r I Permittee Signature: 41,ze,,,Z7
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 AppliefittEivEi)
Site Utilities
FOR OFFICE USE ONLY
City of Tigard Receivedfilfgr r
r 13125 SW Hall Blvd.,Tigard,OR 3 2 3 2 01 DatelBy: �/ Permit No.: PL S .�j((j�
Plan Review 503.718.2439 Fax: 503.598.1960
Other Permit No.:Y TIGARD Inspection Line: . . C1 /Of'
yiGARD
Date Ready/By: .renis:
Internet: www.tigard-or.gov DIVISION H See Page 2 for
TYPE jJ j G
Notified/Method: Supplemental information
BFEE* SCHEDULE
0 New construction ❑Demolition 1 For special information use checklist.
®Addition/alteration/replacementDescription Qty. I Ea. I Total
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
IDAccessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other:
sprkler
JOB SITE INFORMATION AND LOCATION Fire Site utiuti itlities: ( sq.ft.) Page 2
es:
Job site address:14169 SW 134`"Drive Catch basin or area drain 18.76
City/State/ZIP:Tigard,Oregon 97224 n Drywell,leach line,or trench drain 18.76
(1.IL 4,.)('€y 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:134th Drive and Alpine View
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision:Three Mountains Estates Water service(no.linear ft.: ) Page 2
Lot no.:13 Fixture or item:
Tax map/parcel no.:2S19BA-00500 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Replace existing gas hot hater with newer,same size gas hot water heater. Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
'- PROPERTY OWNER 1 [J TENANT Expansion tank 12.51
Name:Ross Crowley Fixture/sewer cap 25.02
Address:14.169 SW 134th Drive Floor drain/floor sink/hub 25.02
City/State/ZIP:Tigard,Oregon 97224 Garbage disposal 25.02
Hose bib 25.02
Phone:(503)334-9969 Fax:( ) Ice maker
12.51
El APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Home Owner Medical gas(value:$ ) Page 2
Contact name:Ross Crowley Primer 12.51
Address:14169 SW 134th Drive Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,Oregon 97224
Solar units(potable water) 62.54
Phone:(503)334-9969 I Fax: :( ) Tub/shower/shower pan 12.51
E-mail:rcrowley(Jme.com Urinal 25.02
CONTRACTOR Water closet 25.02
Business name: ,�� a.n Water heater 1 37.52 37.52
tom• Water piping/DWV 56.29
Address: '
Other: 25.02
City/State/ZIP:
Subtotal 37.52
Phone:( ) Fax:( ) Minimum permit fee: $72.50 72.50
CCB Lic.: /� Plumbing Lic.no.: Plan review (25%of permit fee) 1-t 13 •
Authorized signature: , State surcharge(12%r of permit fee) 8.70
TOTAL PERMIT FEE .A9:S5
I Print name:Ross R.Crowley II _...-EW67''5/Z2/ This permit application expires if a permit is not obtained within 180 days
L after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Se*vice 7�Boaof "
I:1Building\Pennjts'.PI MII-Pem�itApp.doc 10/01/09 440-4616T(10/0JCOMTWE.B) G(� 7C l'
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • Fee( natalSquare Footage: Permit Fee:
50.03 0 to 2,000 $121.90
Footing drain-1"100' 2,001 to 3,600 $169.69
Footing drain-each additional 100' 37. 2 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
Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees QtY• 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 90.00/1u- 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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*.
Qrtanti by Fixture Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate Please check all that apply.
Baptistry/Font 0 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 ❑ New exterior plumbing site utilities for any complex structure
-Drive Aspirator as defined in OAR918-780-0040.
Cu
Dishwasher
her ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher -Commercial-Domestic 0 Any multipurpose fire sprinkler system.
0 Any complex structure as defused in OAR918-780-00
Drinking Fountain
40.
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink -2"
-3"
4 Isometric or Riser Diagram
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food that meet the qualifications above.
Disposal -Domestic-food related
-Commercial-food related
-Industrial-food related
lee Mach.fRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
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 increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
Macintosh HD:Users:rcrowley:Desktop:Replace Hot Water Heater.003:PL2tIU_PertnitApp.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14169 SW 134TH DR, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2017-00204
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Replace water heater - approved
Violation Summary:
Inspector Contractor