Permit (117) CITY OF TIGARD PLUMBING PERMIT
r 2. ,. COMMUNITY DEVELOPMENT Permit#: PLM2017-00530
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/19/2017
Parcel: 1S 134AD03000
Jurisdiction: Tigard
Site address: 10875 SW 108TH AVE
Project: GUIZAR Subdivision: BLACK BULL PARK Lot: 16
Project Description: Replacing 60 ft.of water service.
Contractor: OWNER Owner: GUIZAR, SONDRA B
SONDRA GUIZAR 10875 SW 108TH AVE
10875 SW 108TH AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-260-7277 PHONE:
FAX:
FEES
Quantity Description Date Amount
60 If Water Service 12/19/2017 $62.54
Specifics: 1 12%State Surcharge- 12/19/2017 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 12/19/2017 $9.96
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 requir-. ,ou • follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 9,2-001-0010. 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: Permittee Signature: _ /614- 1 61 j
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
BuildingFixtures; I ;
„� � FOR OFFICE CSE O\Ll'
IIICity of Tigard Received�' Date/By: Permit No.:
i 13125 SW Hall Blvd.,Tigard,'a'. 223 t
Phone: 503.718.2439 Fax: 503.59 i01_. Date/By:Plan Other Permit No.:
T I G A R D Inspection Line: 503 639.4175 ` DateReady/By:
Internet: www.tigard-or.gov liTAuris. See Page 2 for
4 - Notified/Method: Supplemental Information
TYPE,OF t 4.4 . B' ; : 'ER* SCHEDULE'
0 New construction
■ 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 U NSTRUCTTON SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accesso Buildin SFR(3)bath 500.32
rY g ❑Multi-family
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
, A JOB SITE:INFFOORMATION AND. .,OCA1 ON � Site utilities:
Job site address: 1 (j g` -5" cu) i D -e- Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
tC ,=t!ZY j O 7 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: ""(...t 4 CK(Z.-- 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.: 6Q) ` ! Page 2 6,2-5-11
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
t Q�` Qr Backwater valve 12.51
Clothes washer 25.02
ReptG"Vifc� �� , "'0`IJ�`C S4✓i le_. Dishwasher 25.02
k. Drinking fountain 25.02
Ejectors/sump 25.02
b.=miopiltry OW,bIE ' ; x 6 r t: ._1
,. ,_,�. _ ._ ' ,, , , .1 . t w Expansiontu25.02
tank12.51
� c
Fixture/sewer cap
Name: So 0y-c. 4- X'r lCt(�_, 6�c'l,>_,
Floor drain/floor sink/hub 25.02
Address: I D -?S; I v * 1 C___.-
Garbage
Garbage disposal 25.02
City/State/ZIP-r ) O 1___ Hose bib
25.02
Phone:es-03 r}.(4y40 _-7,.-7^) Fax:( ) Ice maker 12.51
-:z a APPLICANT ; coNTA .- pERSbN Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
guy 4 ye
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
,.'GONTI ACTOR Water closet 25.02
- ;;, ' 4', ' °* Water heater 37.52
Business name: /Ky-
Water piping/DWV 56.29
Address:
Other: 25.02
City/State/ZIP: Subtotal 4, �y i
Minimum permit fee: $72.50 71 _S2)
Phone:( ) Fax:( )
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee) 8-_w
Authorized si ature: TOTAL PERMIT FEE
�� 9 F1.
2-0
Print name: �'],1 C kit..., I Date:/,.'f) This permit application expires if a permit is not obtained within 180 days
//( after it has been accepted as complete.
f n' *Fee methodology set by Tri-County Building Industry Service Board.
c .
I:\BuildingTermits\PLMU- ermitApp.doc 1 /01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Qty. " Fee(ea) Total ge Fent&Free+���Tt�lities �Square'Fo�ta �
Footing drain-151 100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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' J 62.54 j1 --' Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation:,k aPermt#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 ' 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
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*. '1.4)1411 eVie'W gr4)li-mbjfg Ia st a +11tn1;
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 ❑ 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" ,
3" SO Ie> C ir'Ristx Diigr In
4"
0 ra 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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
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:
10875 SW 108TH AVE, TIGARD, OR, 97223 December 22, 2017 at
2:25:00 PM
Record Type: Record ID:
Residential - Plumbing PLM2017-00530
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor