Permit Support Document CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT ,. Permit#: PLM2017-00433
Date Issued: 10/23/2017
T t C; li 1 r 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 t'
Parcel: 2S103BD03700
Jurisdiction: Tigard
Site address: 11905 SW FONNER ST
Project: Pacific home remodeling Subdivision: None Lot: None
Project Description: install plumbing for new shower drain. 11/15/17:REPRINTED permit to include(2)sinks and(1)water closet.
6/4/18:REPRINT to add(4)hose bibs.
Contractor: THE PLUMBERS INC. Owner: HUBER FAMILY TRUST
90 NW 150TH AVE 11905 SW FONNER ST
BEAVERTON, OR 97006 TIGARD, OR 97219
PHONE: 503-519-6644 PHONE:
FAX: 503-684-1202
FEES
Quantity Description Date Amount
2 ea Sink 10/23/2017 $50.04
Specifics: 1 ea Tub/Shower/Shower Pan 10/23/2017 $12.51
1 ea Water Closet 10/23/2017 $25.02
Type of Use: SF 1 12%State Surcharge- 11/15/2017 $10.51
Class of Work: ALT Plumbing
Type of Const: 4 ea Hose Bib 06/04/2018 $100.08
Occupancy Grp: 0 12%State Surcharge- 06/04/2018 $12.01
Stories: Plumbing
Total $210.17
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-r: :4•0. You m obtain a copy of the rules
or direct questions to OUNC by calling 503.232 1987 or 1.800.332.2344. , 1)
Issued By: / tr/ er% Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspectio date.
This permit card shall be kept in a conspicuous place on the job site until co •letion of the pr ct.
Approved plans are required on the job site at the time of each inspec • .
Plumbing Permit Application
Building Fixtures ;I�
. f VF:1: FOR OFFICE use. ONLY
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 J UNDate/By: G Permit No.:
0.11111
�) Plan Review ����0��-00�/33
= Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175 �; j Date/By:
TIGARD p R
Internet: www.tigard-or.gov LANt= l Date Jury: I See Page 2 for
-'1
si,LLl '' Supplemental Information
n' TYPE OF WORK '''FEE*SCHEDULE
0 New construction 0 Demolition ;elFor special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement 0 Other:
New 1-2-family dwellings(includes 100 ft.for each utility connection)
Er.:
CATEGORYOF-CONSTRUCTION SFR(1)bath 312.70
E 1 and 2-family dwelling 0 Commercial/industrial SFR(2)bath
437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
: ri JOB„SITE INFORMATION AND'LOCATION Site utilities:
.,gym
Job site address: ?t c,-5 S t„,- Catch basin or area drain 18.76
l csV11�1�� �r5
City/State/ZIP: t�1 'tpk fit Z2� Drywell,leach line,or trench drain 18.76
Ott -
drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: (Project name: 1( 5 .- , _
^'W 1� Manufactured home utilities 50.03
Cross street/directions to job site: Manholes
C) --1.
i L (� 18.76
l -1. cj�I 11�"T _ 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: J Lot no.:
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
,i .;, ` ; P . Backwater valve
t „ t t ( IOC { 'QRK3; '. ; 12.51
4-4Q5
y Clothes washer
�' '� C ` cZ f�S` c, C\. Dishwasher 25.02
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
3'= COPER5 R J G
. ,. . * w 1::.. N., ,A, Expansion tank 12.51
Name: � � r v J' Fixture/sewer cap 25.02
` Floor drain/floor sink/hub 25.02
Address:
� V�r CRS cc -j Garbage disposal 25.02
City/State/ZIP:
Hose bib 14 25.02
Phone:( ) Fax ( ) Ice maker
12.51
,4. . ' PSI w awe i ..kr°.;�4=� ' IT cT 1�N SInterceptor/grease trap 25.02
r 4
Business name: Medical gas(value:$ ) Page 2
Contact name: mel 12.51
Address:
Roof drain(commercial) 12.51
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
_ O "." &( 5 pPPP x . Water closet 25.02
ysr
'it i Water heater
Business name: 37.52
Address: �v t Waterpiping/DWV 56.29
Other: 25.02
City/State/ZIP:
Subtotal
Phone:( Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 44
r
Plumbing Lic.no.: Plan review (25%of permit fee)
Authorized signatu
State surcharge(12%of permit fee)
p TOTAL PERMIT FEE
Print name:S.151,1 j
I I Date:� '.I i i 8 I in
This permit application expires if a permit is not obtained within 180 days
t ! after it has been accepted as complete.
l *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)
PPagelumbing2 Permit ApInformationplication - City of Tigard
- Supplemental
Fee Schedule: Residential Fire Suppression Systems:
Q ' `cla 'e Fo�kog r Fee
t e ed) otah', r
Site i� ilities j. �
Footing drain-151 100' 50.03 0 to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain each additional 100' 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52aIll$tiOli, 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
Othei I speed dew or Fees Qt F'ee(ea). Total' 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
n
accurately report fixtures could result in increased sewer fees* o�p� ew Jor Plumbing installatio
,Quantity by Fjxture Type .:: Plan review is required for any of the following.
F,ixtura Type for ,
kepl*ee/.. Please check all that apply.
Wnrk,rerformed: : Capped Added 9-_ ;kelocaAny
0 ate 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 Than 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial ❑ 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" r Riser-Di I F
4" 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 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 PLUMBING PERMIT
Permit#: PLM2017-00433
i1 . COMMUNITY DEVELOPMENT 111
it a Date Issued: 10/23/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 `F I. ' Parcel: 2S103BD03700
MEMJurisdiction: Tigard
Site address: 11905 SW FONNER ST
Project: Pacific home remodeling Subdivision: None Lot: None
Project Description: install plumbing for new shower drain. 11/15/17:REPRINTED permit to include(2)sinks and(1)water closet.
Contractor: THE PLUMBERS INC. Owner: HUBER FAMILY TRUST
90 NW 150TH AVE 11905 SW FONNER ST
BEAVERTON, OR 97006 TIGARD, OR 97219
PHONE:
PHONE: 503-519-6644
FAX: 503-684-1202
FEES
Quantity Description Date Amount
2 ea Sink 10/23/2017 $50.04
Specifics: 1 ea Tub/Shower/Shower Pan 10/23/2017 $12.51
1 ea Water Closet 11/15/2017 $25.02
Type of Use: SF 1 12%State Surcharge- 11/15/2017 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.08
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 r.• •btain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.3 •- 7
Issued By: �•ermittee Signature: -411/11*
. __._ , V
or
Call 503.639.4175 by 7:00 a.m.for the next available inspec n 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 ,, t .,r,.40a-
FOR OFFICE usl, onLN
aitt'--`' ReceivedCity of TigardF f Date/By: //JJc/i f� � Permit No.:ftm ) 7....c..'l3.
'
- 13125 SW Hall Blvd.,Tigard,OR 223 Plan Review / "'
Phone: 503.718.2439 Fax: 503.598.19N 5 ,,,` Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 �U �,
T 1 G A R D *� V Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov ii. Notified Method: Supplemental Information
TYPE OF 4'OI � v 1st FEE* SCHEDULE "
0 New construction � to'n P�) For special information use checklist
Description Qty. 1 Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCT • SFR(1)bath 312.70
Al-and 2-family dwelling ❑Comm ir : industrial SFR(2)bath 437.78
❑Accessory building [111 Multi-f.n' SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(_sq.ft.) Page 2
dOB SITE INFORMATION AND LOCATION `.r Site utilities:
Job site address: ! 11705 S V VCatch basin or area drain 18.76
tf��
r 51- Catch
leach line,or trench drain 18.76
City/State/ZIP:
Ole Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: v I 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:
Tax map/parcel no.: Backflow preventer 31.27
' 't ": ,' '- ,', ',V Backwater valve 12.51
0�I(� �0 � � �� _ Diswasher 25.02
1 t� �ys Dishwasher 25.02
--Ct V S it C/''le 1 L Drinking fountain 25.02
Ejectors/sump 25.02
ElktROPERTy OWNER '0 TENANT ''''''„ Expansion tank 12.51
Name: Fixture/sewer cap 25.02
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
' El AP ICANT ', 0 CQNTACT 'ERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
c iii
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
OT( CIO `f - Water closet /' 25.02 3-7
. ,, T� -�
-1-1/LL
n ,, ) I Water heater 37.52
Business name: I Y LL „,,,,,,,,,h,,,, ! Yi WaterDWV
i in
p p g/ 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.:
Plan review (25%of permit fee)
�,'/ State surcharge(12%of permit fee)//6,,
Authorized signature: �,e/ - v TOTAL PERMIT FEE '
Print name: X7,1 j�z 6 Date: 11/ I / 1 1- This permit application expires if a permit is not obtained wit80 days
t/ 6 ( l after it has been accepted as complete.
*Fee methodology set by Tri-County Building Induusttryy Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 17(9 CCereO." 't:1;•1.4
tA-VJ1)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities ? Fee lea) lSquare Footage: Permit Fee• -µ
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
'nation: 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 II[Spec tons or Feeqty• 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*. j 4n Review for Plumbing Install* ns-
Quantity
s Quantity byfixture Type Plan review is required for any of the following.
higture 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
Cuspidor/Water 0 Medical gas and vacuum systems for health care facilities.
Aspirator multipurpose
-Commercial
❑ Any fire sprinkler system.
Dishwasher:
-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"
Isotnettic Or Riser Diagram ,
4"
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
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:
11905 SW FONNER ST, TIGARD, OR, 97223 July 11 , 2018 at 8:04:38 AM
Record Type: Record ID:
Residential - Plumbing PLM2017-00433
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Previous corrections completed.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11905 SW FONNER ST, TIGARD, OR, 97223 May 9, 2018 at 2:00:18 PM
Record Type: Record ID:
Residential - Plumbing PLM2017-00433
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Shower pan not inspected prior to cover.
No test or inspection on liner for mud set pan.
AAV's not installed at lays per rough in Inspection notes, dry vent could not get to new
roof area at time of rough in inspection.
Storm piping to Lida rain garden not done at this time.
Caulk base of WC.
Owner to provide permit for additional garage plumbing.
Violation Summary:
Inspector Contractor