Permit (10) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00043
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/31/2019
T t a It.C} g Parcel: 1S135DD03616
Jurisdiction: Tigard
Site address: 11440 SW LOMITA AVE
Project: Ameritrust-LOMITA Subdivision: LOMITA TERRACE Lot: 15
Project Description: Replacing water and waste piping,(1)clothes washer,(2)hose bibs,(1)sink,(2)lavatories,(2)tub/showers,(2)
water closets,and(1)water heater.
Contractor: DONERITE PLUMBING LLC Owner: AMERITRUST RESIDENTIAL SERVICES
4526 MARIA AVE NE 3630 PEACHTREE ROAD NE
SALEM, OR 97305 13801 WIRELESS WAY
ATLANTA, OK 30326
PHONE: 503-313-7793
HONE: 503-364-2668
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 01/31/2019 $25.02
Specifics: 2 ea Hose Bib 01/31/2019 $50.04
1 ea Sink 01/31/2019 $25.02
Type of Use: SF 2 ea Lavatories 01/31/2019 $50.04
Class of Work: ALT 2 ea Tub/Shower/Shower Pan 01/31/2019 $25.02
Type of Const: 1 ea Water Piping/DWV 01/31/2019 $56.29
Occupancy Grp: 2 ea Water Closet 01/31/2019 $50.04
Stories: 1 ea Water Heater 01/31/2019 $37.52
1 12%State Surcharge- 01/31/2019 $38.28
Plumbing
Total $357.27
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 th- rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m. obtain a copy of the rules
or direct questions to OUN .y calling 50% 32.1987 or 1.800.332.2344.
Issued By: ` Permittee Signature:
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
City of Tigard JAN 3 I 2019 Received ,,...,
Date/By: ( i i /-7/Fe-- Permit Ng.../42017 -a '-t3
• 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
llli I Phone: 503.718.2439 Fax: 503.598.196q , Date/By: Other Permit No.:
Inspection Line: 503.639.4175 ,.... ..:_ , „. N Date Ready/By: Juris: 0 See Page 2 for
1 IGARD
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. Ea. Total
, ,Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-family dwelling
to Accessory building SFR(3)bath 0 Multi-family 0 Commercial/industrial
SFR(2)bath
437.78
500.32
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: kk1/4-\qo --m- toy)rk,„ 44,„Q_
Drywell,leach line,or trench drain 18.76
City/State/ZIP: "-"t Z AT i cp._ 97 d..`.93 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: J Project name: Cor-f-1 it 0,,_ 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:
Backflow preventer 31.27
Tax map/parcel no.:
Backwater valve
12.51
DESCRIPTION OF WORK
Clothes washer ) 25.02
,\-kr tArk-N- Lit tNti\'-t- ck,y‘k:',1 .. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
414.apttory OWNER 1-t-' r;.4,4' : 0 wwsa----' Expansion tank 12.51
Fixture/sewer cap 25.02
Name: (. 1.„.14.1-'.\,r,3 ---
Floor drain/floor sink/hub 25.02
Address: 3 6 L2,0 Pt.9.6-,krts,..._ fk ,..) .:. -tht icso. Garbage disposal 25.02
City/State/ZIP: t-' A.ti_ i (AN -3,D5a co Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
AprI4cANTLt5)..,,,,..- - 0t4i. c... iPERSON ,,,,
Interceptor/grease trap
25.02
Business name: tavkl.k .4,... VI1/4.rY1 Vt.. (1.,. ._
6 ‘ Medical gas(value:$ ) Page 2
.-,) Primer 12.51
Contact name: t ( ..k y-\ flkohr,....Y, Roof drain(commercial) 12.51
Address: \L18 43 .3,jiliv3t v't.4...v) C t‘s 1\)€ ..\%4L-, If. Sink/basin/lavatory 3 25.02
City/State/Z1P: ,-)c),...1/4,4x,rN. --) 09, Si... 0 k Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet tt? 25.02
CONTRACTORWater heater' i 37.52
Business name: k . .1A it...._ cL.XY‘bkrta Water piping/DWV I 56.29
Address: \q 0 ....3r-If- ,;t_p,...s.s. t-- --k.--.12._ lc., 0 Other: 25.02
City/State/Z1P: nc.,,ktiv-N, at_ C1 )30 / Subtotal
Phone:r-a..). ) 2(et-t.-010(01 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: (4(0V.) Plumbing Lic,no.: ft 6, 9
State surcharge(12%of permit fee)
Authorized signature.
. ...._,,,. 11
TOTAL PERMIT FEE
Print name: €e,yA \,...„„c\k„,1 Date: 1,- .1) 1.- 1 Qt 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\Pennits\PLMU-PermitApp.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 Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1s'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 r
Storm&Rain Drain-1st 100' 62.54 Valuation. Permit Fee:
$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
UtheP Iipections or'F+ees Fee(ea) Total
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*. Plan Aeview` Qr plulmping Installations
Quan#t:v bb Fixture Tof Plan review is required for any of the following.
Fixture Type for ROatei Please check all that apply.
Work Performed: CalPed' _ Added R1&tC 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall
as defined in OAR918-780-0040.
-Drive
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" _
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:
11440 SW LOMITAAVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2019-00043
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Corrections are complete, plumbing final approved
Violation Summary:
Inspector Contractor