Permit (144) CITY OF TIGARD PLUMBING PERMIT
"s• COMMUNITY DEVELOPMENT Permit#: PLM2018-00554
Date Issued: 12/06/2018
T[GAR i) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 251036610700
Jurisdiction: Tigard
Site address: 12110 SW 123RD CT
Project: Lee Subdivision: YE-OLDE WINDMILL Lot: 27
Project Description: Moving dishwasher,garbage disposal,(1)hose bib,ice maker,and(1)sink for kitchen remodel.
Contractor: TROY ELLIOTT PLUMBING Owner: LEE, MARTIN L&CAROL A LEE TRUS
PO BOX 1958 12110 SW 123RD CT
NORTH PLAINS, OR 97133 TIGARD, OR 97223
PHONE: 503-309-5750 PHONE: 503-590-7341
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 12/06/2018 $25.02
Specifics: 1 ea Garbage Disposal 12/06/2018 $25.02
1 ea Hose Bib 12/06/2018 $25.02
Type of Use: SF 1 ea Ice Maker 12/06/2018 $12.51
Class of Work: ALT 1 ea Sink 12/06/2018 $25.02
Type of Const: 1 12%State Surcharge- 12/06/2018 $13.51
Occupancy Grp: Plumbing
Stories:
Total $126.10
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 OU by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 4111111
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 •roject.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application -,
Building Fixtures FOR OFFICE I SE ()NLN
City of Tigard , 75 Received /
lig I 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: /02, i! i Pe' �`J-2-0
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Line: 503.639.4175 Date/By: t�o`0 G,0(�/p
y
Inspection
T 1 G A It D Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method:
w=F; ' ' ..: v Supplemental Information
'' TYPE:OF=WORK FEE* SCHEDUL
`❑ ew construction 0 Demolition For special information use checklist E
Addition/alteration/replacement El Other: Description Qty. Ea. Total
"
New 1-2-family dwellings(includes 100 ft.for each utility connection)
i„
A#'E(sO YOF COISIORIJc oN ' ' ;may SFR(1)bath 312.70
and 2-family dwelling El SFR(2)bath
X"'
437.78
ElAccessory building ElMulti-familySFR(3)bath 500.32
o Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
4,.,. 4 - I1RFo oOC
x - s_v im,;N AND �± ATIQN Site utilities:
Job site address: 12110 SW 123rd C t. Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 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 4!'° aN og�OI " vx . Backwater valve 12.51
, � ,. .A 4*44._ ,. .-"" Clothes washer
2s.o2
Kitchen remodel
Dishwasher ' 25.02
i'J,2 lG.4-E:1eeta A`ti
Drinking fountain 25.02
Ejectors/sump 25.02
. I
,: - ,,�,, v..._ ' TA 1,t, �, 4 Expansion tank 12.51
Name: Martin and Carol Lee Fixture/sewer cap 25.02
Address: 12110 SW 123rd C t. Floor drain/floor sink/hub 25.02
City/State/ZIP: Tigard, OR 97223 Garbage disposal I 25.02
Hose bib f 25.02
Phone:(503 )50-7341 Fax ( ) Ice maker
l r ., w %.. r 12.51
A , ," s P w . Y NTAL T .F4S y Interceptor/grease trap 25.02
Businessna e: Doug Ziebart Construction, Inc. Medical gas(value:$ ) Page2
Contact name: Doug ZiebartPmer 12.51
Roof drain(commercial) 12.51
Address: PO Box 80402
_ 9basin/lavatory t 25.02
City/State/ZIP: Portland, OR 9 72 80 Solar units(potable water) 62.54
Phone:(503 )307-4114 Fax::(503)245-5433 Tub/shower/shower pan 12.51
E-mail: zbart3@comcast.net Urinal 25.02
Water closet 25.02
' WCTO :
Business name: Troy Elliott Plumbing
Water heater 37.52
Water piping/DW V 56.29
Address: PO Box 1958 Other:
25.02
City/State/ZIP: North P1 ai ns, OR 97133
Subtotal
Phone:(503)390-5750 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 152130 Plumbing Lic. 34_4 2 p Plan review (25%of permit fee)
/ .. State surcharge(12%of permit fee)
Authorized signature: , s i
, /U TOTAL PERMIT FEE
i 1
Print name: �o I ', a Date: 1 -29-18 I This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
�j *Fee methodology set by Tri-County Building Industry Service Board.C.
I:�BuildinePermits LMU- 'tApp.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:
Qtr. ;Fee(e ) = Total
e 00; permit`Fee; n..
r� 1a
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:
t ' � 4
Water Service-each additional 100' 37.52 a vat �i
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
�. � txx 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.
90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 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 ! g '
606vfor i'lu�thg.
Quantly by Future Type Plan review is required for any of the following.
'tetiluei Please check all that apply.
Fiorkture Type Performed: Capped Adder, Relocate
W�rk ,�. 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 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 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" r '
O*Ott'i oir Riler Piagrani
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.doe 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12110 SW 123RD CT, TIGARD, OR, 97223 January 17, 2019 at
9:57:10 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00554
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor