Permit (35) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00031
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/24/2019
Parcel: 2S103CCO2800
Jurisdiction: Tigard
Site address: 13965 SW AERIE DR
Project: MITRA Subdivision: EAGLE POINTE Lot: 3
Project Description: Replacing(2)sinks and(1)shower pan for bathroom remodel.
Contractor: CROWN PLUMBING Owner: MITRA, KEERTHI A
5241 NW SKYCREST PKWY SRIKANT,ARCHANA
PORTLAND, OR 97229 13965 SW AERIE DR
TIGARD, OR 97223
PHONE: 503-771-9449 PHONE:
FAX: 503-771-9454
FEES
Quantity Description Date Amount
2 ea Sink 01/24/2019 $50.04
Specifics: 1 ea Tub/Shower/Shower Pan 01/24/2019 $12.51
1 12%State Surcharge- 01/24/2019 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 01/24/2019 $9.95
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: Permittee Signature: A1
-
NMI
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 I. (111.1( 1 I !+1 0x1 x
City of Tigard R Date Be Permit No
.' �� < t) Received
• 13125 SW Hall Blvd,.Tigard,OR 97223 plan Remy,
Date Ry Ri� /� j "`" � 1� oRi
II
2�i19 I
: II Phone: 503 718.2439 Fax: 50.3.598.1960J 6 Other Permit No
&I.6,,c ()/9 All it 1
Inspection Line: 503.639.4175 Date Readv`By Jun ® See Page 2 for
{It 11tI) �q &
Internet: www.tigard-or.gov '� (3 y Notitied.,hlethod: Supplemental Information
{°i rt FEE* SCHEDULE
TYPE OF WO;�a ILO.J@3imG 1,7I�10S0x
0 New construction ■ Demolition For special information use checklist
Description 1 Qty. 1 Ea. Total
0 Additionlalterationtreplacement 0 Other: New 1-2-family dwellings(includes 100 ft.fix each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)hath 500.32
0 Accessory. building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13965 SW Aerie Dr Catch basin or area drain 18,76
t)rywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg.iapt.no.: j Project name:Mitra Manufactured home utilities 50.03
Cross street/directions to job site:SW 123rd Terrace Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear II. ) Page 2
Storm sewer(no.linear It.. ) Page 2
Water service(no.linear It ) Page 2
Subdivision: Lot no.: Fixture or item:
Wax map/parcel no.:2SI03CCO2800 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
new shower pan,sinks,faucets,updating shower fixtures,update tub filler Dishwasher 25.02
tempering valve Drinking fountain 25.02
Ejectors/sump 25.02 1
(l PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25 02
1 Name:Keerthi Mitra&Archana Srikant
Floor drain/floor sink/hub 25.02
Address: 13965 SW Aerie Dr �5 0� 1
Garbage disposal
City/State/ZIP:Tigard,OR 97223 Hose bib ] 25.02
Phone:(503)579-3534 Fax:( ) Ice maker 12.51
+.< APPLICANT ®CONTACT PERSON Interceptorigrease trap 25.02
Business name:Maughan Design Medical gas(value:S ) Page 2
Primer 12.51
Contact name:Daryl Oberacker
Roof drain(commercial) 12.51
Address: 1910 NNS'Lovejoy St. Sink/basin/lavatory 2 25.02 �,x a> �5 ,C-Ii
City/State/L1P:Portland OR 97209 Solar units(potable water) 62.54
Phone:(503)241-4059 I Fax::( ) Tub/shower/shower pan I 12.51 12.51
E-mail:orders'a'.maughandesign.com Urinal 25.02
Water closet 25.02
CONTRACTOR -
Water heater 37.52
Business name:Crown Plumbing Water pipingiiDWV 56.29
Address:5429 SE Francis St Other: 1 25.02
City/State/LIP:Portland,OR 97206 Subtotal ( , 55-
Minimum permit fee: $72.50 72.5(1
Phone:(503)771-9449 I Fax:( ) t
CCB lie.: 163063 Plumbing Lic.no.:PB1I36 Plan review (25%of permit fee)
r State surcharge(12%of permit fee) 8.70
Authorized signature: 1 , k ry"-,, {-^t ( TOTAL PERMIT FEE
i s This permit application expires if a permit is not obtained within 180
Print name:Tiara Siderius Date: 1/23/19 after it has been accepted as complete. `'
*Fee methodology set by'1'n-County Building lnduotry Service Board
I.d3uilding'Permits,PLMI.I-Perm i'pp dt.: 10 0)(14 440-40 I(ST(I0 402-1:0M.WEB t
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty, Fee tea) Total 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- 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 Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Stone&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
Other Inspections FeesFee(ea) Total each additional$100.00 or fraction thereof,to
peCons or 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-1i2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$5().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 $50.001.0(1 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge- 12 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/FontPlease check all that apply.
Bath -Tub/Shower 0 Any new commercial building with water sers ice 2"and
lacurci;whirtpool greater.except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose tire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach.iRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gane
-Stall
SinkiLav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractorincrease of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:lUsers\Joni\AppData\Local\Microsoft\Windows\1NetCaehe\Content.OutgooklIWKVQS1,I\PLMF_PermitApp-MITRA(002ldoe
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
13965 SW AERIE DR, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2019-00031
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
Note: existing plumbing slow to drain.
Violation Summary:
Inspector Contractor