Permit t CITY OF TIGARD PLUMBING PERMIT
191 11. '.- COMMUNITY DEVELOPMENT Permit#: PLM2019-00260
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/24/2019
Parcel: 1 S 136CA04201
Jurisdiction: Tigard
Site address: 11110 SW 79TH AVE
Project: Marina Subdivision: FRIENDLY ACRES Lot: 6
Project Description: Adding(3)water closets, replacing(1)gas water heater, replacing(1)sink, replacing(2)Lavatories,and re-pining
house. 6/26/19: REPRINT to correct owner information. 7/1/19: REPRINT to add 20 LF water service.
Contractor: OWNER Owner: MARINA GULAKOVA
MARINA GULAKOVA 11110 SW 79TH AVE
11110 SW 79TH AVENUE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-580-1664 PHONE: 503 580-1664
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 06/24/2019 $25.02
Specifics: 2 ea Lavatories 06/24/2019 $50.04
1 ea Water Piping/DWV 06/24/2019 $56.29
Type of Use: SF 3 ea Water Closet 06/24/2019 $75.06
Class of Work: ALT 1 ea Water Heater 06/24/2019 $37.52
Type of Const: 1 12%State Surcharge- 06/24/2019 $29.27
Occupancy Grp: Plumbing
Stories: g0 Investigation Fee 06/24/2019 $90.00
11 Investigation Plumbing 12% 06/24/2019 $10.80
State Surcharge
20 If Water Service 07/01/2019 $62.54
0 12%State Surcharge- 07/01/2019 $7.51
Plumbing
Total $444.05
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. to 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 inspectior�ate
This permit card shall be kept in a conspicuous place on the job site until compl= '.n of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures � "'. roR 0U11C1: l sr' 0y1.1
City of Tigard JUL 1 2019 ReceivedB •. / �� Permiy� 1024 y,j t/C/
II III13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: / 6 /
= Phone: 503.718.2439 Fax: 503.598.196a'=a Plan Review Other Permit No.:
Date/B
T I G A R D Inspection Line: 503.639.4175 a's-'- a �`a�) Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
.z:' v zas :r .--�.,.�, ,.=mss:N� 4,44,. .,,;:z....%- . ..s..x..-, ...» . ..a.,..�..._ re _. x _._ _ _ .....= =. _ s
❑New construction 0 Demolition For special information use checklist.
Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
`CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
rt 9B SITE INFORMATION AND LOCA ioN.,-?,_ Site utilities:
Catch basin or area drain 18.76
Job site address: //// 762th/e
�•�� Drywell,leach line,or trench drain 18.76
City/State/ZIP: -/ Q 9/
�r �� ' ,��`- G Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: i Project name: 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. ) i Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Vit r u Backwater valve 12.51
} Clothes washer 25.02
VW A /)I)el/l4l f� /9'00 �6 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
t er " 41X-474'::
7 ': ' W. Expansion tank 12.51
via g x., � .�> � ��
�A�jI,/ -3 � //� Fixture/sewer cap 25.02
Name: ✓"/(tet �� �-
``J �j� Floor drain/floor sink/hub 25.02
Address: ////0 ,5 ��` /'V Garbage disposal 25.02
City/State/ZIP: // '* , 0/2 9'7223
Hose bib 25.02
Phone:(,9::).5) - 766y Fax ( ) Ice maker 12.51
. „..rS, xu' _ ®) t y, Interceptor/grease trap 25.02
Business n e:
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
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
..-;„:17 t t v ., i m2. Water closet 25.02
._< ',7,_ .&= r'< , '.
Water heater 37.52
Business name: DCti/if r f Waterpiping/DWV 56.29
Address: 1 Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
_- Ah State surcharge(12%of permit fee)
Authorized signa . . '. 1Pr TOTAL PERMIT FEE
Print name: �/ Al Date: �J . This permit application expires if a permit is not obtained within 180 days
/Kyf 7 "� ( � / after It has been accepted as complete.
*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:
bite UtilitiesQty. Fee(ea) Total ki: e 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
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
F ¢� each additional$100.00 or fraction thereof,to
Other Inspections or 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" yew".r, Iimbing Installatiol $
Quantityby Fixture Type Plan review is required for any of the following.
Fixture Type for • Repine/ 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
Drive Thin 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 ❑ 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"
, t. Isol trig or K1s* IN.111
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
Tel: 503.718.2439
Location: Inspection Date:
11110 SW 79TH AVE, TIGARD, OR, 97223 September 6, 2019 at
11 :52:24 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00260
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
CITY OF TIGARD PLUMBING PERMIT
' ' ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00260
T f(r,A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/24/2019
Parcel: 1 S136CA04201
Jurisdiction: Tigard
Site address: 11110 SW 79TH AVE
Project: marina Subdivision: FRIENDLY ACRES Lot: 6
Project Description: Adding(3)water closets,replacing(1)gas water heater,replacing(1)sink,replacing(2)lavatories,and re-pining
house.
Contractor: OWNER Owner: NIX,TREVOR&KATHRYN
MARIA GULAKOVA 11110 SW 79TH AVE
11110 SW 79TH AVENUE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-580-1664 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 06/24/2019 $25.02
Specifics: 2 ea Lavatories 06/24/2019 $50.04
1 ea Water Piping/DWV 06/24/2019 $56.29
Type of Use: SF 3 ea Water Closet 06/24/2019 $75.06
Class of Work: ALT 1 ea Water Heater 06/24/2019 $37.52
Type of Const: 1 12%State Surcharge- 06/24/2019 $29.27
Occupancy Grp: Plumbing
Stories: 90 Investigation Fee 06/24/2019 $90.00
11 Investigation Plumbing 12% 06/24/2019 $10.80
State Surcharge
Total $374.00
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 follovy the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yip 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:
Vi
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 completiont the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
:Slit ; tilities (NY- Fee( ) Total:_ uareFootage: Permit-Fee:, -r.
Footing drain-1st 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
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
Other Inspections or Fees 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*. Man Review io r' l mbing'Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type far *wised Please check all that apply.
Work Performed.. . . rapped Added Relocate
Baptistry/Font 0 Any new commercial building with water service 2"and
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
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 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"
3 sy , 1
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