Permit (101) CITY OF TIGARD• PLUMBING PERMIT
■` COMMUNITY DEVELOPMENT
Permit#: PLM2019-00052
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2019
Dg Parcel: 2S102AC00800
Jurisdiction: Tigard
Site address: 12553 SW MAIN ST
Project: Senet Subdivision: None Lot: None
Project Description: Interior plumbing:Adding(1)dishwasher,(3)2"floor drains, (1)ice machine,(6)sinks,and(1)water closet;
Installing(1)water heater;Replacing(1)sink.
Contractor: A&D PLUMBING INC Owner: XU,YU
PO BOX 57 HAN,ZIYE
TROUTDALE,OR 97060 10755 SW NAEVE ST
TIGARD, OR 97224
PHONE: 971-275-2751 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 02/11/2019 $25.02
Specifics: 3 ea Floor Drain/Floor Sink/Hub 02/11/2019 $75.06
1 ea Ice Maker 02/11/2019 $12.51
Type of Use: COM 7 ea Sink 02/11/2019 $175.14
Class of Work: ALT 1 ea Water Closet 02/11/2019 $25.02
Type of Const: 1 ea Water Heater 02/11/2019 $37.52
Occupancy Grp: 1 12%State Surcharge- 02/11/2019 $42.03
Stories: Plumbing
Total $392.30
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:
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
BuildingFixtures v F.�,,
FOR orFlc�. I:SL o��L\
City of Tigard .I{Y.F Received
1[ IDate/By: Permit No.: t•-
14
il 13125 SW Hall Blvd.,Tigard,OR 97223 7�t�� �/�-G ��-
Plan Review
Phone: 503.718.2439 Fax: 503.598 19pj‘_ ,Lm-,`, ; Date/By: Other Permit No.:c
T I C A R D Inspection Line: 503.639.4175 ( ,a ' IV ,,- J`Page ���'�1�v2�
Internet: www.tigard-or.gov $ p ! " „ < -. Date Ready/By: runs: ® See 2 for
Notified/Method: l0 Supplemental Information
TYPE OF WORK FEE* SCIIEDULF
0 New construction 0 Demolition For special information use checklist
Description Qty. Ea. I 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 gfommercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
y
JOB SITE INFO• . TIO14 ND LOCATION Site utilities:
r .
Job site address: �,�,j Catch basin or area drain 18.76
Z `/ �, ,7��� Drywell,leach line,or trench drain 18.76
City/State/ZIP: it/
drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:SSI.,,e_,-1- �0 h tk5 e-, Manufactured home utilities 50.03
Cross street/directions to job site: Y 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: l0 \ Lot no.:
�'��t'�1.1G Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
.# 'DES
Backwater valve 12.51
Clothes washer
/p � l / 25.02
ket,,/ .74 ..., % /,,,/ rejj.1fz-,./f h 1 r/� Clothes
1125.02 25;00 It
/✓1✓ / /92.1.4-z),,,,.. ) kf*t d'Ly re.--,,- d-Y Drinking fountain 25.02
Ejectors/sump 25.02
PRQPEk' i' O*NER - 0 TEINTI'' T,, „ Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 3 25.02 -7.5-,4;1� lt\
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax ( ) Ice maker I 12.51 / ,;`
Interceptor/grease tra� !FLICAI+iT . � �] CONfAl1GT PERS011I,# P 25.02 1
Business name: f �„,,,i,7.....,.. Medical gas(value:$ ) Page 2
�✓ r`Are, Primer 12.51 1(1
Contact name: /�
/Y �f4,/,,---- "'� Roof drain(commercial) 12.51
Address: /7 is C/�4 / ✓/ f 7 /7 l
/�+ XPi Sink/basin/lavatory 25.02 Ai
City/State/ZIP: 6 t 5A t ,- 97d.j 4) Solar units(potable water) 62.54
Phone:((7 7l) 27 S yy Fax::( ) Tub/shower/shower pan 12.51
E-mail: ur+d",/t,"b ,„2„ C4711 c o Urinal 25.02
(/v Water closet 25.02
;..„ W NTRACTOR Ay:,(.1,Z
Water heater 37.52 3'),,j-a
Business name://,,t.-/D -
���� ,?,,,,,,./.__.4. , ,, /,,,c' Water piping/DWV 56.29
Address: /fi/j- /9/z 6 4.4 Other: 25.02
City/State/ZIP: 6 r e5 h C C)f 170 3 0 Subtotal 35.2) ;t 7
Phone:(I 7/)0175127 5/ Fax:( ) Minimum permit fee: $72.50
CCB Lic.:z/Z.Z39 Plumbing Lic.no.: Pb577 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 4/.2,6),)
Authorized signature: n
TOTAL PERMIT FEE J q),3,r)
Print name:�� i�j Date:' -/ This permit application expires if a permit is not obtained within 180 days
"Y_ L4�"/ y after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\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: h 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' 37.52 Valuation: Permit Pee: ''
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
Feed Total each additional$100.00 or fraction thereof,to
Other Inspections fir'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*. Plan Review.f r Plumbing Installations `,
t)ivantit�y by Fixture,Type ., Plan review is required for any of the following.
Fixture Type for RMIsee/ Please check all that apply.
Work Performed: Capped = Added Relocate
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
Cuspidor/Water Aspirator I, ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
-Domestic i ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" 3
w
3"
- ... Rw SOffietz`:leAXa+ise = g
4"
0 Isometric or riser diagram i3 required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related J `J��
-Commercial food related L.1f i U z'�,1r�t j f-r- g✓,c:. g/7/I! `.
-Industrial food related G/
Ice Mach./Refrig.Drains Comments regarding fixture work: S;1,•44 G✓`<<
frr
Oil Separator(Gas Station) U�'/igeieel 'thh
Rec.Vehicle Dump Station crwK /ilra:yi ZV•.!
Shower: -Gang
-Stall
/'. 1‹:- I
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related 6
-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:
12553 SW MAIN ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2019-00052
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Correction is complete, plumbing final- approved
Violation Summary:
Inspector Contractor