Permit (32) CITY OF TIGARD PLUMBING PERMIT
U ` COMMUNITY DEVELOPMENT Permit#: PLM2018-001
85
TI c_;A I<:p:, 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/26/2018
Parcel: 2S102BB00809
Jurisdiction: Tigard
Site address: 10210 SW BROOKSIDE PL
Project: Greenwell Subdivision: BROOKSIDE PARK Lot: 3
Project Description: Replacing laundry,lavatory,and kitchen DVW piping in crawlspace and connecting it to sanitary sewer.
Contractor: TUALATIN VALLEY PLUMBING LLC Owner: GREENWELL, EDDIE F
12042 SE SUNNYSIDE RD#277 10210 SW BROOKSIDE PL
CLACKAMAS, OR 97015 PORTLAND, OR 97223
PHONE: 503-607-7242 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 04/26/2018 $56.29
Specifics: 1 12%State Surcharge- 04/26/2018 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment- 04/26/2018 $16.21
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 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 • calling 503.232.1987 or 1.800.332.2344.
Issued By:
-j� A ;A.�� / Permittee Signature: al'''-
Air
Call 503.639.4175 by 7:00 a.m.for the next available i .-ction 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 Applicata r:r,.__, ,,
Building Fixtures
FOR OFFICE USE ONLY
City of Tigard APR 2 L Received - 'r
5 n't3
Date/By: liZ 67 /W-permit No.: if
111 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
1111 li Phone: 503.718.2439 Fax: 503.598.c:96;d ' Date/By:
Other Permit No„4...t feAcW72:),..Z
Inspection Line: 503.639.4175 BU ,.',.' ' , . .N!
Date Ready/By:
1 IGARD
hms 1 l0 See Page 2 for
Internet: www.tigard-or.gov
Notified/Method: Supplemental Information
TYPE,,.OF WORK FEE* SCHEDULE _
0 New construction 0 Demolition For 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)
CATE:GoRiL' OF,CONSTRUCTION SFR(1)bath 312.70
701-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 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: 1 o-2_1'0 __6,J BrookS'i GIL_ p‘
City/State/ZIP:
Drywell,leach line,or trench drain 18.76
Vo 1 0 O. CV1 213
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Cie,,,,-„ce_jrN vj c 1 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
Storrir sewer(no.linear ft.:_ ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision:
Lot no.: Fixture or item:
Tax map/parcel no.: , , _ , , Backflow preventer 31.27
vibWai tikikt 4 4 p, , , ''''''' '91 '' g ,-, Backwater valve 12.51
Clothes washer 25.02
k_.c"\i keNtir•,i \--AA/ i (< 1.tC.-- .C.
v‘ k---N Dishwasher 25.02
.e24:in.:s'fitvi., -f,e 0,-, Drinking fountain 25.02
S ktr.--1e_tr--, eidie:pla,„....4,i0v.-1.- 3.,,,..., 5,\--A • \47( 1.,-1 ciek taayt Ejectors/sump 25.02
P#O)'ElrrV ;* '0*, if:,:f -.4 : -,.rj-T Expansion tank 12.51
Fixture/sewer cap 25.02
Name: •E.64 d) 4_ Gi Y-4-e vi u3'-e ( \
Floor drain/floor sink/hub 25.02
Address: I O21-0 „..; ,,,-,„3, 0 lc cLe.. P I
- Garbage disposal 25.02
City/State/ZIP: Q 0,1-•.0, ,c1 t)e' . Ci 72? 3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
A#PilleANIT l' ' . ,:'. 1. 0'CONTACT PERSON \
14
Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: 'Ti/0\1 CA-fi r., V a,LA..,,,i pic„•,,,,,,b,not .11 c_
a- Primer 12.51
Contact name: j___,_rrkte Pe47.-l-e 'S
Roof drain(commercial) 12.51
Address: eV:La* /0, 1 2.0 Liz 'Sur\et ri 5:etc Rai mi-ri-2 7-7
Sink/basin/lavatory 25.02
City/State/ZIP: C I tk CIC. M. s Oa, q 70/3 Solar units(potable water) 62.54
Phone:( 3) 667 771-12- I Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: 1--P 0 4--vftlat 4 r) Veklit (Am,Jo'i oka. • C 0/4-1
Water closet 25.02
PrPtAc:44'olt Water heater 37.52
Business name: 7 Lia I ok:t's tTh VA 114_/ P I OM h1'\ i:( C-. Water piping/DWV
11 I 2556..0229
Address• i 2. )/./-2, .6'„hi\tr\ ..1 SCI lc p21, v vl%,4-- 277 Other:
City/State/ZIP: r)A L 5 ,c,A c) 7 01:3 Subtotal
Phone:(SO ) /607 7 z_if 2....... Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 22 00 77 Plumbing Lic.niefr..,2,0 a y
State surcharge(12%of permit fee)
Authorized signature:
TOTAL PERMIT FEE (51.2r,
Print name:(2) ,.______ 4 "--- I Date: 47L/.2..6)f_9 1 This permit application expires if a permit is not obtained within 180 days
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)
11...........M........M.E=MMM --__
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
*Site F e 1 l=. . tage; Permiit Fee'•' 4 :
Qty. a tea) -Total4, '•� 1 11' ;FQ4
�. �ae� n ,� � � �
Footing drain-1' 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' 37.52 '~
'Val>ltat1ott � ` Permit Feet �~ y ,_4A
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
� e (eaI and $10,000.00.
®theflaspecto* or Fees`~ including
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.
$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*. tl iew or Plummmg-instafa Qfs .vim rx
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type forReplace/•, Please check all that apply.
Capped Performed:
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.
-Jacnl7i/Whirlpool ❑ 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 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" on r c or s a yr*n
0 Isometric or riser diagram is required for new buildings
-Car Wash Dram 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:
10210 SW BROOKSIDE PL, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2018-00185
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Replace waste lines for laundry,lav, & kitchen- approved
Violation Summary:
Inspector Contractor