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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2019-00001 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439a Date Issued: 1/2/2019 U Parcel: 2S111 AA00300 Jurisdiction: Tigard Site address: 14085 SW HALL BLVD Project: DALLIER Subdivision: None Lot: None Project Description: (1)clothes washer and(1)tub for basement bathroom. 10/7/21: REPRINT to add(1)clothes washer (replacement)to permit.8/9/22:REPRINT to add(1)lav,(1)tub/shower, (1)water closet,and repipe. Contractor: OWNER Owner: DALLIER,JEFFREY JEFFREY DALLIER 14085 SW HALL BLVD 14085 SW HALL BLVD TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503-804-0306 PHONE: FAX: FEES Quantity Description Date Amount 2 ea Clothes Washer 08/10/2022 $50.04 Specifics: 1 ea Lavatories 08/10/2022 $25.02 2 ea Tub/Shower/Shower Pan 08/10/2022 $25.02 Type of Use: SF 1 ea Water Piping/DWV 01/02/2019 $56.29 Class of Work: ALT 1 ea Water Closet 08/10/2022 $25.02 Type of Const: 1 12%State Surcharge- 08/10/2022 $21.77 Occupancy Grp: Plumbing Stories: Total $203.16 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 Issued By: Permittee Signature: l 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 HECEIVE� City of TigardReceived P t 13125 SW Hall Blvd.,Tigard,OR 97223 A U`1 Date/By: Plan Review Phone: 503.718.2439 Fax 503.598.1Other Permit No.: C�PfY OF TIGARb Dae/By: Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris ® See Page 2for Internet: www,tigard-or.gov Notified/Method: Supplemental Information K.w�v,�, � ❑New construction ❑Demolition For special in ormadon use checklist Description I Qty. I Ea. I Total ikAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) SFR(1)bath 312.70 ® I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ElMulti-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 <- Site utilities: Job site address: 7 S SW i Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: Tip -7 17, Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: 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 Stone 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 Backwater valve 12.51 Clothes washer 25.02 � �r e ('V 1 Dishwasher 25.02 pimAcwtDrinking fountain 25.02 wi fo+Ce rre- ' eva r Ejectors/sump 25.02 Expansion tank 12.51 Name ' Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: J d W Garbage disposal 25.02 City/State/ZIP: 1 t`. r R„ Hose bib 25.02 Phone:('�o 3) Fax:( ) Ice maker 12.51 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 d.15,0 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet i 25.02 .09 Water heater 37.52 Business name: �!vr�t /r Water piping/DWV 56.29 ts Address: Other: 25.02 City/State/ZIP: Subtotal R Lq. Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: �, ` o TOTAL PERMIT FEE Print name: i Date: 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. 1-\Build inglPermits\PLMU-Permi1App.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suepression Systems: it a (!3 ` 484# r. lam, "-z, Footing drain-1 s`100 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,601 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-I st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas S stems: Water Service-each additional 100' 37.52 �� Storm&Rain Drain-1 st 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 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. + Qua nti b yFixture`f`-a Plan review is required for any of the following. Fixture Type for Rfirlace! Please check all that apply. WorkPerformedi 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/Whirl oo] Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water idor/Water As irator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial El Any multipurpose fire sprinkler system. ElAny complex structure as defined in OAR918-780-0040. Domestic Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: 2" r �f ., r _3„ � OWN 4" R 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./Refri .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 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical,and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: ❑ I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date ❑ I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or NA I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. fEPP PTam Permit Applicant t r of Per Applicant Date Permit M Address: Issued by: Date: This Copy for Permit Offices CITY OF TIGARD PLUMBING PERMIT S COMMUNITY DEVELOPMENT Permit#: PLM2019-00001 T t Gl RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/02/2019 Parcel: 2S 111 AA00300 Jurisdiction: Tigard Site address: 14085 SW HALL BLVD Project: L'ALLIER Subdivision: None Lot: None Project Description: (1)clothes washer and(1)tub for basement bathroom. Contractor: OWNER Owner: L'ALLIER, JEFFREY JEFFREY L'ALLIER 14085 SW HALL BLVD 14085 SW HALL BLVD TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503-804-0306 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Clothes Washer 01/02/2019 $25.02 Specifics: 1 ea Tub/Shower/Shower Pan 01/02/2019 $12.51 1 12%State Surcharge- 01/02/2019 $8.70 Type of Use: SF Plumbing Class of Work: ALT 35 ea Minimum Fee Adjustment- 01/02/2019 $34.97 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 by calling 503.232.1987 or 1.800.332 2344. / . Issued By:�� ure: .7—....00--- t d Call 503.639.4175 by 7:00 a.m.for the next available inspect'.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 City of Tigard ,'y t .„ "- Received1 Permit No.:• 13125 SW Hall Blvd.,Tigard,OR 97223Date/By: Ø/i�rf►'�,�� -��t ��� 1111 I Phone: 503.718.2439 Fax: 503.598.196 2 2019 Plan Review Other Permit No.: c _ - 1 ��_, Date/By: �(pfO t C�K tL� I. t,n]t D Inspection Line: 503.639.4175 �*�y Date Ready/By: luck: H See Page 2 for Internet: www.tigard-or.gov , -i tl l' % IG. .� Notified/Method: ,r.r„ Supplemental Information TYPE OF ,Q N(i DIVISION FEE* SCHEDULE 0 New construction 0 Demolition For special information use checklist Description Qty. j Ea. I Total 3 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGOOa Off' C.'ONSt'RUCTION 't`" SFR(1)bath 312.70 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory buildingMulti-family SFR(3)bath 500.32 0 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 , I .'E 3N oRMATIOI -"At AND/ 1G 0 " ,", ,s Site utilities: Job site address: V?V Uii J11 r t'k l a I) B l v Catch basin or area drain 18.76 V City/State/ZIP: �`nr,`7 0P) 9-7ggy Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 J Suite/bldg./apt.no.: il Project name: Manufactured home utilities 50.03 Cross street/directions to job site: reA, f-t�\t 4 f " �!P ortA• Manholes 18.76 1 �n f e !c ! x f 1[) 1%F54):)3± Rain drain connector 18.76 rSanitary sewer(no.linear ft.:_) Page 2 C "���(���" 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.: I r A A 2 0 c) Backflow preventer 31.27 • � I T'1.00 Jt-tiJ x•---v 5Backwater valve 12.51 . t i' ION OF WORK "'' ' ' '' ' °'"`'` Clothes washer I 25.02 : 1-pr,--4-,...1) b� � /►\ ti��ZA'1'iY�/'� r et'm Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 , a PROPERTY OWN 1,'": r'� Ci ' Expansion tank 12.51 Name:414 t LAII itr Fixture/sewer cap 25.02 / y^ l Floor drain/floor sink/hub 25.02 Address: if � Hc, ( U'Vni Garbage disposal 25.02 ! City/State/ZIP: e I I,- t O? 179.9,C./r Hose bib 25.02 Phone:(5-t?a) ad qc G) Fax:( ) Ice maker 12.51 0 P 0 COACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: Primer 12.51 Contact name: 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 i 12.51 0,,S E-mail: Urinal 25.02 -,.; Water closet 25.02 Water heater 37.52 Business name: e...4,,,44,-;,/--- Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal 737„� it f i nmum permit $72.50 7 Phone:( ) Fax:( ) MirZ•3 CCB Lic.: a Plumbing Lic.no.: Plan review (25%of permit fee) .----- r i, State surcharge(12%of permit fee) 57"-k) Authorized signature: '',�y j ,„..6......„, TOTAL PERMITFEE .37/ )z)jThis permit application expires if a permit is not obtained within days Print name: y�.;tF , t�� Date: i 7,2. ./ q180 after it has been accepted as complete. !/ *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PennitApp.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: Site Utilities • Fee(ea) - ,Totalquare Footage: Permit Fee: 'gin Footing drain-IS'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 « rx ,. Storm&Rain Drain-1st 100' 62.54 nati011: " , � :" $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 Q Fee(ea) �"� tai each additional$100.00 or fraction thereof,to Ins r �,i ;.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 (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*• ' f �,k, , , .for- 'IuD t, i 'tallith)nsa, ., Quantity by . f Type'': Plan review is required for any of the following. Fixture Type for Plee check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑asAny new commercial building with water service 2"and 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 Drive • - as defined in OAR918-780-0040. Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. 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" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. 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/Sery/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