Permit (126) CITY OF TIGARD PLUMBING PERMIT
►.
COMMUNITY DEVELOPMENT €noir' Permit#: PLM2017-00317
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/03/2017
TIGARD g �� Parcel: 2S111CA00400
Jurisdiction: Tigard
Site address: 15195 SW 98TH AVE
Project: Nelson Subdivision: ALDERBROOK FARM Lot: 10
Project Description: (2)sinks,(1)tub,and(1)shower in second story bathroom. 11/20/17:REPRINTED permit to show change of
contractor,and relocating(1)clothes washer,(1)sink,and(1)water closet for laundry room.
Contractor: RANIERI PLUMBING LLC Owner: NELSON, GARY&SANDRA
2229 NE BURNSIDE ST STE 132 NELSON, KEVIN ERIC
GRESHAM, OR 97030 15671 SW SUMMERFIELD LN
TIGARD, OR 97224
PHONE: 503-894-0107 PHONE: 503-639-9539
FAX:
FEES
Quantity Description Date Amount
45 Misc Administration Fee 11/20/2017 $45.00
Specifics: 1 ea Clothes Washer 11/20/2017 $25.02
3 ea Sink 11/20/2017 $75.06
Type of Use: SF 2 ea Tub/Shower/Shower Pan 08/03/2017 $25.02
Class of Work: ALT 1 ea Water Closet 11/20/2017 $25.02
Type of Const: 1 12%State Surcharge- 11/20/2017 $18.01
Occupancy Grp: Plumbing
Stories:
Total $213.13
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 SOAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: d/ y,. Permittee Signature: ,. ,'
l'/—+ _ d.44-C 1 Z 122 :' `1"--L
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 FixturesFOR OFFICE USE owLi
CityRECEIVED
Tigard of Ti d Received
g Date/By: // //7 --/97 Permit No.:�`e�/V) 7, v3i 7
111 13125 SW Hall Blvd.,Tigard,OR 97223
2 2
_ Phone: 503.718.2439 Fax: 503.598.19 a 2017 17 Plan Review
Date/By: Other Permit No.:
Inspection Line: 503.639.4175
T I G A R D Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov CITY OF Tit(. A� Notified/Method:D
Supplemental Information
�. TYPE OF W ��D�1VG1 DIVISION .. �...,. FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description Qty. I Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCT t Ni,_ SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Comm-rci4 ii 4,. 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
i 13 SITE INFORMATION;ANT)LOCATION Site utilities:
Job site address: /9/9..e.')- jl /‘1,<:-14-1' C7/,e-j Catch basin or area drain 18.76
City/State/ZIP: l - . - Drywell,leach line,or trench drain 18.76
-%�d4 ce e r/ - - y
(+ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: V Project name: ,(/�,4 n A/ei3(7,-) 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:
Tax map/parcel no.: Backflow preventer 31.27
=: xs = Backwater valve 12.51
? tet M ,DESCRIPTION OF W RI{
_ Clothes washer I 25.02
�_1, "�.h/y c-97 4 e! `.c''...6P,W: `u` -
/ �"/" � Dishwasher 25.02
f) at:/4^•e--) Z.�I�4-S'i-e-1 (.) 3,Vwf t e4,--of 6 tt,t47 Drinking fountain 25.02
je-44,A.4 � �, Ejectors/sump 25.02
6( {_,_. 0 P itPERTY OWNER w £, TEL'' ';a=x Expansion tank 12.51
Fixture/sewer cap 25.02
Name: �' 2 / k1-4-2-A /11 � /6.:.0/1 iCi.)/56.7L
yy Floor drain/floor sink/hub 25.02
Address: / Ji .5'a/ u i 1/1 VY11%il�i /,,[ "1, Garbage disposal 25.02
City/State/ZIP: i
/rCL �Y J-- � Hose bib 25.02
Phone:( C,. (� �5 Cj Fax ( ) Ice maker 12.51
'APPLICANT ( k " ONTACT PERSON Interceptor/grease trap 25.02
Business name: //��� �� Medical gas(value:$ ) Page 2
tU G`fit A_ Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 1 25.025 ;.
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
J
'CONTR t TOR N '
Water closet /
25.02 25 r;
s'� '-- - Water heater 37.52
Business name: Aa,i I er-L (-Aum bin .. Water piping/DWV 56.29
�c
Address: AI) 503U Other: 25.02
City/State/ZIP: //e,i �7T2-- �� �7U/� Subtotal ?�,t,D
Phone:( ''O 7/7 `6 ',7 ) Fax:( ) Minimum permit fee: $72.50
t� R Plan review (25%of permit fee)
CCB Lic.: / 07`7 Plumbing Lic.no.: 81 ✓ _
State surcharge(12%of permit fee) '
Authorized signalnxe: �/ /
/T/" /VieL S // 7/1/02 TOTAL PERMIT FEE({
Print name: l (61 l� 1� / �
` ---'\ Date: This permit application expires if a permit is not obtained within 180 da
// C (7
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building1Pennits\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 A 1g '
Qty. Fee(ea) 'Total Scare Foo e. Permit` e:
Footing drain-1 t 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
'Valua cin: 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 $5,00'1.O0 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other inspections or'Fees Qt. Fee(ea) Tom each additional$100.00 or fraction thereof,to
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*. x` Plan Review fo ;Plumbing Installations x.
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
0 Any new commercial building with water service 2"and
Baptistry/Font 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
as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
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" 1somQtt4C or Riser Diagllt _..
kn
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
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
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request q st for Permit Action
TI G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Ownerpplicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) 54 /',,g /1/.- -4- 0/111
Mailing Address: /lj(t0 7 I j GI! S rvf^Ylor4?//
City/State/Zip: t_` C 0/
Phone No.: Vi' _1;J `7c=3,
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
la___ZdOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
MOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel .ermit
p )
Permit#: ,1-',42:26)%.7 3 i'j 7
Site Address or Parcel#: �$"��� ,4r
Project Name: � c
Subdivision Name: Lot#: —
EXPLANATION: ::' 44 /' t l5 lip v--
ACL. rat) i t� �: tdf� y/cam
Signature: 9L' 1 `Yl (kg-624471 Date: /,/-- --/7
Print Name:
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
Route to Sys Admin: Date By Route to Records: Date $
Refund Processed: Date By Invoice Processed: Date y
Permit Canceled: Date By
I:\Building\Forms\RegpermitAction_092314.doc By Parcel Tag Added: Date By
CITY OF TIGARD PLUMBING PERMIT
''' COMMUNITY DEVELOPMENT Permit#: PLM2017-00317
f f G tltt D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/03/2017
Parcel: 2S 111 CA00400
Jurisdiction: Tigard
Site address: 15195 SW 98TH AVE
Project: Nelson Subdivision: ALDERBROOK FARM Lot: 10
Project Description: (2)sinks,(1)tub,and(1)shower in second story bathroom.
Contractor: OWNER Owner: NELSON, GARY&SANDRA
KEVIN, GARY&SANDRA NELSON NELSON, KEVIN ERIC
15195 SW 98TH ST 15671 SW SUMMERFIELD LN
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503-639-9539 PHONE: 503-639-9539
FAX:
•
FEES
Quantity Description Date Amount
2 ea Sink 08/03/2017 $50.04
Specifics: 2 ea Tub/Shower/Shower Pan 08/03/2017 $25.02
Type of Use: SF 1 12%State Surcharge- 08/03/2017 $9.01
Plumbing
Class of Work: ALT
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
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 1.800.332.2344.
Issued By: C f
Permittee Signature: f. c/
144,
-
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 .
City of TigardCliiDate/By: 3/J 7 /377- PermitNo.: + -3 i 7
, '1 7-
13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
4 ! Other Permit No.: -�,rt !.t lii t)
■ Phone: 503.718.2439 Fax: 503.59 Date By: �,�/rw��i
Inspection Line: 503.639.4175 Read/B Jur s: H See Page 2 for
T I G A R D � Ready/By: � Supplemental www.tigard-or.gov (_ Notified Method: i�i Information
- TYPE OF WORK NW,N, )FEE*SCHEDULE
P
For special information use checklist.
❑New construction 0 PC11 r IA1 t IA Description Qty. Ea. Total
❑Addition/alteration/replacement Eli- yti' �1 New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CO UCTION SFR(1)bath 312.70
SFR(2)bath 437.78
❑ 1-and 2-family dwelling 0 Commercial/industrial
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: /579c," j(X/ ��' � !
.y 'al'
/ Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1�&1,9i?� 617 "v al`(I Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: ).0/2.M r2 Manufactured home utilities 50.03
Cross street/directions to job site: 6a &IL&/Z,; 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: Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
r ERItii IOIFORIC, i =f Backwater valve 12.51
iO
.1.,' '� m �'. -1'-' ,a. ,- '' Clothes washer 25.02
(21) S W(�,�j I b. /i i(j e6i) �, tATC.r/ Dishwasher 25.02
d Drinking fountain 25.02
Ejectors/sump 25.02
*. 12.51
PROPERTY 0 i` " 'TENANT v xr Expansion tank
Fixture/sewer
wer cap 25.02
Name: G .SO ' Je9FLs6/�
pii -N Floor drain/floor sink/hub 25.02
Address: j 4-6`7( (,() Sitill l�y(,J1•h .p t r.� _ Garbage disposal 25.02
City/State/ZIP: j iG.,412 Hose bib 25.02
/ Ice maker 12.51
Phone:(�G'2j) (ta �j q - c,(_.;--- � Fax ( )
Interceptor/grease trap 25.02
0 APPLICANT ws it] CONTACT' PERSON
Medical gas(value:$ ) Page 2
Business name: ...LS cc- Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory ,2. 25.02 5e.01-7
City/State/ZIP: Solar units(potable water) 62.54
Tub/shower/shower pan r2 12.51 ,;/....3".,0.1.
Phone:( ) Fax::( )
Urinal 25.02
E-mail: Water closet 25.02
COPi I RACTOR Water heater 37.52
Business name: �� Water piping/DWV 56.29
Address: I Other: 25.02
Subtotal
City/State/ZIP:
Minimum permit fee: $72.50 75.,d e
Phone:( ) Fax:( ) Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) I- 0
Authorized s": ature: /1.�E� j e/i// TOTAL PERMIT FEE p f. 7
i "�� '� This permit application expires if a permit is not obtained within 180 days
Print nam.:. i i' Date: ,-3 --/ 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 tea) Tei Share boa#ale: R tiPermitdee: ' k
Footing drain-l'100' 50.03 0 to 2,000 $121.90 r
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' 37.52 Medical Gas Systems:
Storm&Rain Drain-1st 100' `Valllittit n:' P, rtnit Fee: ,'
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
Qty. F (eat Total each additional$100.00 or fraction thereof,to
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*. 4 PI i Review for Plumbing I stallatio "``
Fi•
xture Quantity by Fixture Type Plan review is required for any of the following.
Type for Replace/..x 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 Thru 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"
Isome#10 or ,, serPinricim
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
I-ndustrial 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
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:
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:
15195 SW 98TH AVE, TIGARD, OR, 97224 January 14, 2019 at
9:35:16 AM
Record Type: Record ID:
Residential - Plumbing PLM2017-00317
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Fix leak at tub valve handle Upper level tub.
Seal Lay counter top to wall upper level bath. 407.2
All else appears ok.
Re call after corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15195 SW 98TH AVE, TIGARD, OR, 97224 January 16, 2019 at
9:32:45 AM
Record Type: Record ID:
Residential - Plumbing PLM2017-00317
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
Corrections complete.
Violation Summary:
Inspector Contractor