Permit (171) INR}
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019 00145
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/09/2019
Parcel: 2S111 CC16800
Jurisdiction: Tigard
Site address: 10160 SW HIGHLAND DR
Project: Young Subdivision: SUMMERFIELD NO.4 Lot: 219
Project Description: Install(1)shower pan.
Contractor: PLEASANT VALLEY PLUMBING INC Owner: YOUNG, ELIZABETH R REVOC LIVING
13540 SE ELLEN DR 10160 SW HIGHLAND DR
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503-380-8124 PHONE: 503-806-6856
FAX: 503-658-5576
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 04/09/2019 $12.51
Specifics: 1 12%State Surcharge- 04/09/2019 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 04/09/2019 $59.99
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
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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: ti\`-�' \---f—N-......._
` Permittee Signature: ` fl.
Call 503.639.4175 by 7:00 a.m.for the next availab • spec '•n date.
This permit card shall be kept in a conspicuous place on the job site un ' completi .f the project.
Approved plans are required on the job site at the time of each inspec ion.
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Plumbing Permit Application
Building Fixtures RECEIVE FOR OF PIC Ii SF O\LI
City of Tigard APR 9 2019 RDate/By: 4 k t t‘A c.
Permit No. 1/4-\--, k ` k.k�
11111 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.19C((T,ITY OF TIGARD Date/By: Other Permit No.:
TIGARD inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
fa 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 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INF91RMATION AND LOCATION Site utilities:
Job site address: /
l O(C'�0 S 1'7177 /04. Catch basin or area drain 18.76
L
/ Drywell,leach line,or trench drain 18.76
City/State/ZIP: .-7-:/6?/ / / e74L 9.? 9-3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: y0 VZ ji"l.2- Manufactured home utilities 50.03
Cross street/directions to job site: J uj t%1, z/1-21,, lc( 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:
Tax map/parcel no.: Backflow preventer 31.27
DESCRP"TION O 'O� P' L Backwater_ valve 12.51
` f Clothes washer 25.02
mgt/ q l(llam/t 5-t t'(ti ( vt d a e'?s I ) ' Dishwasher 25.02
* 71 4.-64) IA i ie-- CI - /Y\0 v d., P7a, V Drinking fountain 25.02
Ejectors/sump 25.02
yr ,.r Expansion tank 12.51
PROPERTY OWNER 0 TNPINT F 4: ,,x.4
Name: ...,, t " ( k vi aer Fixture/sewer cap 25.02
1 Floor drain/floor sink/hub 25.02
/ mac O
Address: G D /G 0 S -z) illy k I f��C p e_. Garbage disposal 25.02
City/State/ZIP: '�j5'l,�/'G,e / c)g....- q 71_2-3 Hose bib 25.02
Phone:(161) 9C)& ,7S;jam, Fax:( ) Ice maker 12.51
APDL C T ,, 0 CONTACT P *t ON Interceptor/grease trap 25.02
Business name: �4- 1.- _; scwAwilonwo Medical gas(value:$ ) Page 2
_: � , . Primer 12.51
Contact name: / ���}��1 , / (commercial)
/ Roof drain 12.51
Address: 3 t{ L'{ $ v ,jiz iex. (34--- el
y Sink/basin/lavatory 25.02
City/State/ZIP: A i'(0 gt.,14-i�-/ CY -- j�✓ 7-'- Solar units(potable water) 62.54
Phone:tf 5) � -1 G(J Fax::(----)----- Tub/shower/shower pan 12.51
E-mail: f' L.ctL -- ed IAc/11'1.-e 6,1" ,,:,'-t el rr/c e o vvi Urinal 25.02
,. Water closet 25.02
CONTRACTOR.
.w1. Water heater 37.52
Business name: fie e.i J- 1/fid i 1 rki oie b t r Water piping/DWV 56.29
Address: / f S �_ vvE//e. Dll4 t Other: 25.02
City/State/ZIP: C.14,6" ,-6(01 xL S t/J-" 17 di SSubtotal
Phone:62,j) 3 i() - 0( 2_1 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: /2 il 1..(,.5-... �„�(may Plumbing Lic.no.:3 3 r e-j Pb Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: t TOTAL PERMIT FEE
f /� This permit application expires if a permit is not obtained within 180 days
Print name:..2/77 ....-}1-e-41.�1,�t/ Date:� Y`( 7 after it has been accepted as complete.
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*Fee methodology set by Tri-County Building Industry Service Board.
I.\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 Qtr. Fee(ea) 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-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: Permt 'ee:
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
Qty, Fee(ea)'' Total
each additional$100.00 or fraction thereof,to
Othear Inspections or Feesand 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 for Plumbing InstallattWns#
Quantity by Fixture Type) Plan review is required for any of the following.
Fixture Type for _ Replace/ Please check all that apply.
WorkPerformed: 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
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic El 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"
isomei1c or i.1s r Diagram
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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2