Permit CITY OF TIGARD PLUMBING PERMIT
11. COMMUNITY DEVELOPMENT Permit#: PLM2019-00199
T t ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/09/2019
Parcel: 2S103CA00104
Jurisdiction: Tigard
Site address: 13125 SW 115TH AVE
Project: DAVIS Subdivision: None Lot: None
Project Description: Converting existing laundry room to a bathroom and installing(1)water closet,(1)tub/shower,and(1)lavatory.
Replacing(1)tub/shower and(1)sink.
Contractor: OWNER Owner: DAVIS,JAMES
JAMES DAVIS 13125 SW 115TH AVE
13125 SW 115TH AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-949-9951 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Sink 05/09/2019 $50.04
Specifics: 2 ea Tub/Shower/Shower Pan 05/09/2019 $25.02
1 ea Water Closet 05/09/2019 $25.02
Type of Use: SF 1 12%State Surcharge- 05/09/2019 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 unti/completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures • V FOR OFF1cE USE. ONLY
Received
City of Tigard ,j t� . d Permit No.:
II 13125 SW Hall Blvd.,Tigard,01687%203 0, 1.0...0- � Date/By: `.1
/ �/ /�` "� � �� ��
Plan Review
1111 _ Phone: 503.718.2439 Fax: 50 19 Q�0 Other Permit No.:
Inspection Line: 503.639.4175 �\�y \C?PS\0� Date/By:
t I Cr A R D J\ Date Ready/By: Juris: Bl See Page 2 for
Internet www.tigard-or.gov 0 \
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iupn,p1,7 talInformatr. ir . " , 17-: er aa p ,- ,,ii gn or . ,/„ New
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❑rD inolion < ® ,
For special information usechecklist _
Description i Qty. I Ea. I Total
CAddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
" r y SFR(1)bath 312.70 9 t 99 L 9'994499°P7° `
437 78
JR 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath
500 32
❑Accessory building 0 Multi-family SFR(3)bath
Each additional bath/kitchen 25 I
LI Master builder
0 Other: Fire sprinkler( sq.ft.)
Page 2
wa } ,< -/, , r' 1i 7f'a /Hid Site utilities:
Job site address [5 / i
. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP.
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: ,VD j >yy' f�i&) Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Mil/1 e i 5 /06 it 6P' u 5-e- 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
"P?//'''
�rirra�Iyr �y,� ` r , m I Backwater valve 12.51
t a' , a�� '` � h,> b 25.02
Clothes washer
/1 1 , 5(1�yA, ._ °-I a U /� /7 TV Offl Dishwasher 25.02
lG la( e 1'7X l�t-i'e`r- / i-) mum ii- Drinking fountain 25.02
' '- stns r a J Ejectors/sump 25.02
s ''i '')**4.(1(.14-"/ . -*:"'', l' Expansion tank 12.51
Name: J aryl e5 Oav-1 Fixture/sewer cap 25.02
d its tJ� Floor drain/floor sink/hub 25.02
Address: [5/ J SW u S
�f Garbage disposal 25.02
City/State/ZIP:7 /e i b f2_ Hose bib 25.02
Phone ) Fax ( ) Ice maker
12.51
�r%% \ �x r
H�" , r, war 4/%/ r�, '“%7, �r �4 - Medical
ga (value:ase trap Page 25.02
Business name: Medical gas $ ) 2
Contact name:
.it../y.1
Primer 12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory -t 25.02 �,Vl.,
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
i rt- y� %rg/rf/ ��r Water closet 25.02 t
Water heater 37.52
Business name: ,, Water piping/DWV 56.29
Address: Win.6r-
Other: 25.02
City/State/ZIP: Subtotal fai,01.53
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: Plumbing Lic.no.:
Plan review (25%of permit fee)
J State surcharge(12%of permit fee) /2 ,C)
Authorized signature: / . . TOTAL PERMIT FEE //,, of
Print name Tot"_ n Date: �_f _.__,_._...__This permit_application expires if a permit*La
s not obtained within 1 SO days._
di ✓� after it has been accepted as complete.
"Fee methodology set by Tri-County Building IndustryService Board.
440-46i6T(10/02/COM/WEBI
I:\Buildinu\Permits\PLMU-PermitAoo.doc 10/01/09
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
'Sue A \ \\ t' t� \ � ao _ot,a .•= ; � n1t g0; i „a .
, \\l
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 ' SAV w`\, lA 'V y4 *w
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
ii ��,
each additional$100.00 or fraction thereof,lu
y�� Peen)
fir.Tnspet�+�p �c��P'" e�- < �vv ` � ; 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 bt atturc'C pe ,riP 'Revie*tfor'P 1dm'k bin; tafl t o 1 s4
Pixtur Fype fiirV�, .'' 4epia t Plan review is required for any of the following.
erk'Perftormed ` irped < ; Added\4 ;Ttelarste
Please check all that apply.
Baptistry/Font
EJAny new commercial building with water service 2"and
Bath -Tub/Shower
-Jacuzzi/Whirlpool 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 fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2"
-- Submit sets of plans with any of the above.
1it' tS 1r �
„ ,.. , >� t} iic Qr N,„. � .: e
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./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang .
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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