Permit (181) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00101
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/13/2019
T f C;A 1'D 9 Parcel: 2S102AD01601
Jurisdiction: Tigard
Site address: 9037 SW BURNHAM ST
Project: DeAngelo Subdivision: None Lot: None
Project Description: Replacing 450 ft of water line.
Contractor: PIPELINE PLUMBING Owner: 9037 BURNHAM LLC
333 S STATE ST SUITE V-108 9037 BURNHAM ST
LAKE OSWEGO, OR 97034 TIGARD, OR 97223
PHONE: 503-793-9020
PHONE: 503-624-1906
FAX: 503-624-1926
FEES
Quantity Description Date Amount
450 If Water Service 03/13/2019 $212.62
Specifics: 1 12%State Surcharge- 03/13/2019 $25.51
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $238.13
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Sta - of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will exp.e if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires yo o follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-00/0090. You,may obtain a copy of the rules
or direct questions to OUNC by calling 503.23 . 987 or 1.800.332.2344.
Issued By: Permittee Signet e: (,.b
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.
v.;..rt v{
Plumbing Permit Application
Building Fixtures MAR 1 3 7E1 9 FOR 014 1( 1 SI. O\1.\
City of Tigard Received / t (7 " �� � i`1.
Date/By:By: /J 'ermit V
13125 SW Hall Blvd.,Tigard1LOR 97223 •
_ Phone: 503.718.2439 Fax 503.598.1960 • Plan Review Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: .auris: 10 See Page 2 for
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. 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 j'Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
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: 10 3 51A)51A) 6 Catch basin or area drain 18.76
�0 A Drywell,leach line,or trench drain 18.76
City/State/ZIP: Ii 40 C 2
7 17Footing drain(no.linear ft.: ) Page 2
� � g
Suite/bldg./apt.no.: Project name: 'A 4s(/a'S w� (, ;VC C ^ Manufactured home utilities 50.03
Cross street/directions to job site: l Manholes 18.76
)t) r N I-1....et.- Ve 1.yt.w Ife-4 Air 4,t,}' Rain drain connector 18.76
�l 45 ,-J{. 0 e /14-,r- /,. Sanitary sewer(no.linear ft.:_) Page 2
66 u Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:4(1)() 1 Page 2 2.42.042.,
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
li ciapri l OE.a m„I Backwater valve 12.51
j / Clothes washer 25.02
rGfr lit-L-t 1/, L.i n� C� 5j-J �t- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPER~ �.O J ..... ❑ ,ANT.. Expansion tank 12.51
Name: S ii h r�e Qi Fixture/sewer cap 25.02
D
Floor drain/floor sink/hub 25.02
Address:
i Co 3 9 3 Q3 S 2- Garbage disposal 25.02
City/State/ZIP: ! 7 2 g / Hose bib 25.02
Phone:10 1 ) 7i 1- 1 o V Fax:( ) Ice maker 12.51
:v '.- 0 MolliiCANT 4. 43 CONTACT' PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name:
� � i `5 <'St�uC Primer 12.51
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
Water closet 25.02
• CONTRACTOR
� Water heater 37.52
Business name: g J i"( /1`7( / . Water piping/DWV 56.29
7 S (�
Address: `
3 S j t-,h it<- S 11-Y-e-c t4 Other: 25.02
City/State/ZIP: C, ) ,, c. Subtotal
Phone:( ,3) i 2 27 _ /<j C (, Fax:( ) Minimum permit fee: $72.50
CCB Lic.: / 4 g j c Plumbing Lic.no.:
Plan review (25%of permit fee)
` State surcharge(12%of permit fee)
Authorized signature: > �;) L G
V TOTAL PERMIT FEE
) / This permit application expires if a permit is not obtained within 180 days
Print name: _✓ L /y after it has been accepted as complete.
re e:- !.,•i• e/, Date: j �/,
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(l0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty• (ea) Total Square Footage: Permit Fee:
Footing drain-151 100' 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 tso 0
Valuation; Permit Fee;, .: ,
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
Other Ins ectons or'Fees ' Fe# Total. each additional$100.00 or fraction thereof,to
p 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 how) each additional$100.00 or fraction thereof.
Subtotal: 111- 42i
't n. �1'
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*. an Review for Plumb gInstallations
Quantity by FixtereType Plan review is required for any of the following.
Fixture Type.10 Replace/ 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
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic ❑ 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
that meet the qualifications above.
Garbage -Domestic non-food
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:
9037 SW BURNHAM ST, TIGARD, OR, 97223 March 29, 2019 at
10:11 :24 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00101
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Water pressure = 80 psi
Violation Summary:
Inspector Contractor