Permit (76) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00064
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/20/2018
Parcel: 2S111CC08000
Jurisdiction: Tigard
Site address: 15795 SW GREENS WAY
Project: BERRY Subdivision: SUMMERFIELD NO.2 Lot: 107
Project Description: Bathroom remodel:(1)sink,(1)tub/shower,and(1)water closet.
Contractor: B&G EXCAVATION& PLUMBING LLC Owner: BERRY, KENNETH M&SANDRA L
4241 SE 136TH 15795 SW GREENS WAY
PORTLAND, OR 97236 TIGARD, OR 97224
PHONE: 503-761-2038 PHONE:
FAX: 503-762-6710
FEES
Quantity Description Date Amount
1 ea Sink 02/20/2018 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 02/20/2018 $12.51
1 ea Water Closet 02/20/2018 $25.02
Type of Use: SF 1 12%State Surcharge- 02/20/2018 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment- 02/20/2018 $9.95
Occupancy Grp: Plumbing
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 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:
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 USE ONE)
City of Tigard ReceivedQil Dale/B � 1//�� PermitNo.: /)13125 SW Hall Blvd.,Tigard,OR 97BECZIVEr) Plan Review:111 111 /✓
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I c;A IZ D Inspection Line: 503.639.4175 F E B 2 0 Z 01 8 Date Ready/By: loris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
=` %• k . , ',. TYPE.:OF WO:. WON , FEE* SCHEDULE
❑New construction I�..® �� � �
■ 1 emolition For special information use checklist
Description Qty. Ea. Total
Addition/alteration/replacement 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
p
❑Accessory building EtMulti-familySFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE I1!FORMAT:ION,AND r
OCAT1ONF, Site utilities:
Job site address: ��--7 Q ! ! _. N Catch basin or area drain
1 / ( (•� 1C.fi�L�9?0l���tz�- 18.76
City/State/ZIP: '7 ' ` Drywell,leach line,or trench drain 18.76
I 7R--;._
; Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: y . 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
." ESeRIP*OIN OF ` i,f,, Backwater valve 12.51
7) 1__ Clothes washer 25.02
1 `T Yi `t J.c'i \T Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Cl P LOPERT�,O R ,U ] ENAIVT Expansion tank 12.51
Name: a Fixture/sewer cap 25.02
t"t y's , WA/AAA Ifr3CX' 1ir'1
Address:
t Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APLIIN "r- Ni` NT:ACT PERSON Interceptor/grease trap 25.02
Business name: N. 'c)‘ }\ Medical gas(value:$ ) Page 2
Contact name: ___`' 6 Primer 12.51
� �' Roof drain(commercial) 12.51
Address: r ( 1� C� ,...A,^4< I-- Sink/basin/lavatory , 25.02 „Ll
City/State/ZIP: .\-,:;„)‘_,,z,...._-)- c7
' .1.5 - i! 1.7 Solar units(potable water) 62.54
Phone:(6 , 3) .,9` J Fax::( ) Tub/shower/shower pan I 12.51 i) -57
E-mail: j<-, i< ,-)I
a t_ 0 i Urinal 25.02
Co t1 1 OI Water closet ( 25.02 i 0 Z
,� .- �. . ' < Water heater
37.52
Business name: (� + 6, k p1I Water piping/DWV 56.29
Address: ' t h
I! t-/( L I5(-` , Other:
City/State/ZIP: - 25.02o
Vi._,,,---1-- c,"-N,(�. Subtotal �'S
Phone:(' '7 j Fax:( ) Minimum permit fee: $72.50 -a
Plan review (25%of permit fee)
CCB Lie.:
1 :3\73 Plumbing Lic.no.: .--} B (-�'_ ,
State surcharge(12%of permit fee) r..-7,
Authorized signattir4v:72 t
,e_rA/1- TOTAL PERMIT FEE r-I. 31)
i ca Date: This permit application expires if a permit is not obtained wi hin 1> days
Print name: �ye.,C C.:.._,
J 1 I 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:
Sites:Dtilities,x .... fir. Fee(ea) To{tal, Square Footage: „ > Permit Fee:
Footing drain-l'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' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fie:
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/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 how) 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*. ,., 'lan Review for Plumbing Instaliati ns R, s
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
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
-Domestic
0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" �?
r Isometric or RisertDiagram
0 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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2