Permit (13) CITY OF TIGARD PLUMBING PERMIT
'1 COMMUNITY DEVELOPMENT Permit#: PLM2019-00004
Date Issued: 01/08/2019
T i[; y R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 103C 604200
Jurisdiction: Tigard
Site address: 12270 SW MARION ST
Project: Price Subdivision: WILLAMETTE NO.2 Lot: 21
Project Description: Replacing water heater.
Contractor: POSEIDON PLUMBING Owner: PRICE,JOHN H&NORMA J
13640 SE HWY 212 12270 SW MARION ST
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503-561-1417 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 01/08/2019 $37.52
Specifics: 1 12%State Surcharge- 01/08/2019 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment- 01/08/2019 $34.98
Plumbing
Class of Work: ALT
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 • OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire •rk is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t. • • the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00'I ''t may obtain a copy of the rules
or direct questions to O by calling 503. 32.1987 or 1.800.332.2344.
Issued By: /P4/,/ Permittee Signature:
iJ t�I
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 ApplicatirtE94
Building Fixtures FOR OFFICE CSE 011.1
City of Tigard JAN 8 2019 Received / /t
OR 97 3 Date/By: r/ '//A '' ii�C J
ol 11111 13125 SW Hall Blvd.,Tigard,
Plan Review
16 Phone: 503.718.2439 Fax: 503.59 1960 '',1. Date/By: Other Permit No.:
Inspection Line: 503.639.4175 BUILD'AC3 L' v/It�.!ON
TIGARD Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORT( j FEE* SCRE0bLE
❑New construction 0 Demolition For special information use checklist
Description Qty. I Ea. Total
p,Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
M, CATF OW- OF CONSTRUCTIOI •` SFR(1)bath 312.70
01.5
Z1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
SITE ORAATION_ Site utilities:
Job site address: /L`Z 7() 57,A.,/ ,E} 6 Catch basin or area drain 18.76
I � „‹... Drywell,leach line,or trench drain 18.76
City/State/ZIP: �yike4,5 oC�i 9'7za 5 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/d'g.
ectio to job site: ,/. Manholes 18.76
Ape /L, ea Rain drain connector 18.76
�J (((��/� [l GGG��� 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
Backwater valve 12.51
1 D ' 1 10, F.'''''. RK "- ,:.
= / `" Clothes washer 25.02
4/`f 'L{�' G �/ ><ee �� Dishwasher 25.02
/ Drinking fountain 25.02
Ejectors/sump 25.02
{{ '' Expansion tank 12.51
`ID . • 0 PR e ,' O ., , I ,7 , r,, TENANT'-',
,".
Name: 4e3Ayt /77;<--e___
77`<--�D Fixture/sewer cap 25.02
// Floor drain/floor sink/hub 25.02
Address: -,/l Garbage disposal 25.02
City/State/ZIP: tf` -� Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
p iM'YLIC r J,, x'' CI NTAc pARS614 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
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
<.; n Water closet 25.02
CONTRACTOR
<'
Business name: &, ?, /G� /04�� c Water phiepaitnegr/DWV / 37.52
5
56.29
Address:i::;y?3#I j./4 Other: 25.02
City/State/ZIP4( ( i2O 0Subtotal
Z.-
Phone:
Phone:(fil ? (f
Fax:( ) 7 ii 1.2_0 Minimum permit fee: $72.50
/ Plan review (25%of permit fee)
CCB Lic.: 2/ 2Yg 2/A(/f'7 Plumbing Lic.no.: l S L� .-
State surcharge(12%of permit fee)
Authorized sign - / TOTAL PERMIT FEE
Print name: {
V /� 9Date: //2 f!y g This permit application expires if a permit is not obtained within 180 days
l TTT �� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PennitApp.doc 10/01/09 440-46I6T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Oty. Fee(ea) Total
SiteUtilities Square Footage: Permit Fee:
Footing drain-1"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' 37.52t
.vahlatiOnt:.. er .
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) a Total each additional$100.00 or fraction thereof,to
Other Inspections or r!eeS,, 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*. 1
a1ItOnew s
Quantity by flxture Type ,` Plan review is required for any of the following.
Fixture Type for "' Replace/c "x Please check all that apply.
Work Performed: 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
ngi
-Jacuzzi/Whirlpool
e neer.
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
Thras defined in OAR918-780-0040.
-DrivCuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ 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"
3,> v metr c or Riser Diagram „
4
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/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:
12270 SW MARION ST, TIGARD, OR, 97223 January 14, 2019 at
12:08:16 PM
Record Type: Record ID:
Residential - Plumbing PLM2019-00004
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Water heater approved.
Violation Summary:
Inspector Contractor