Permit (102) CITY OF TIGARD PLUMBING PERMIT
,_
` ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00279
Ti[.;A R I.7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/15/2019
Parcel: 1 S134AD05600
Jurisdiction: Tigard
Site address: 10720 SW PONDEROSA PL
Project: YE-HEALY Subdivision: BLACK BULL PARK Lot: 23
Project Description: Removing and replacing furnace and adding an A/C unit and a heat pump. Placement of A/C unit must comply
with manufacturers requirements.
Contractor: OWNER Owner: YE-HEALY, DONG Q
DONG QUIN YE-HEALY 10720 SW PONDEROSA PL
10720 SW PONDEROSA TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-969-5873
HONE: 503-969-5873
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 07/15/2019 $25.02
Specifics: 2 ea Water Closet 07/15/2019 $50.04
1 12%State Surcharge- 07/15/2019 $9.01
Type of Use: Plumbing
Class of Work:
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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.
IThcc----'------
Issued BY: >xfir(, ./r/hfe.A----Permittee SignatureT 1.. SJ
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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
Building Fixtures
r'''--- Received /.....„.
City of Tigard JUL, i --, ,-,1';',,q Date/By:
41 13125 SW Hall Blvd.,Tigard,OR 97223 ju1- '.,- "' '
I Phone: 503.718.2439 Fax: 503.598.1960
Ill Plan Review
Date/By: / 7/727`.-Rermit Noiah/tfoL0/1_...ct)01:27
0;lifyfele/Rae,-.ai coe....,
TIGARD Inspection Line: 503.639.4175 C', ' ' " ' Date Ready/By: Jul.'s. 0 See Page 2 for
Internet: www.tigard-or.gov tjU iLL.;,,.(.-.1 L2;I,, -,'' Notified/Method: Supplemental Information
r...,-,-.... --.i,mr.,-...-.:f."7.:,,,-.x.:174,.....- i......,„,-.--,irfte----tijoitos-1,-,,,,,,,,:.::..--',--,4,-.1*...4-,•.,..,..,-.4,,,,,,,-,7.-,...7 „-,,,,,,z:: ,, 4-,-^.."1"L'''il'Aper.s i i::::. r.1.4,--:',,,,..=.•.",...'!",4,44. ,7,,,,-•V
0 New construction 0 Demolition For special information use checklist.
Description Qty. Ea. Total
71.Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF-CON , SFR(1)bath 312.70
1.6 1-and 2-family dwelling 0 Commercial/industrialSFR(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-INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: i(.? 72,....."0 5 i,i/ poNcie rrxs'ok_ p Catch basin
leach line,or trench drain 18.76
City/State/Z1P: "ri,..,„ ,. 9 p..... q 7 2_,.2...3
'J Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 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.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
O". "N OF
Backwater valve
12.51
Clothes washer / 25.02
P_pkt. u,k 2 -fo,Iptc Dishwasher 25.02
Cja.lh C-7 tA)t.. 12-,-- Ve"-TIL-17) _ Drinking fountain 25.02
Ejectors/sump 25.02
- : TT oviim, „.,,,,-1 i.t - a tENTANi -,i:Z...3, - Expansion tank 12.51
Fixture/sewer cap 25.02
Name: D.-.)/1,e. 0/7,1. ye, - Ir.
Floor drain/floor sink/hub 25.02
Address: f et 72_0 (Al Roydszyt)) ,,,_ 12 L
Garbage disposal 25.02
City/State/ZIP: Ti.cio ,n2( O,-.. q 7223 Hose bib 25.02
,
Phone:(i rb, )t 61 - lit Fax:( ) Ice maker 12.51
--.4,,,,,;•A '-' 0 APPLICANT ,'•".7*14:17%. 0 emir . ,,,:: ,N •1•45:: 7'• Interceptor/grease trap 25.02
1 '4' 014....k. ,,.."..-...;41tain, : '''` ;.-
Medical gas(value:$ ) Page 2
Business name:
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
Urinal 25.02
E-mail:
Water closet .2_ 25.02
CeNritk."," - ' :1;7,; 'il Water heater 37.52
Business name: .v- -c Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone:( ) Fax:( )
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
Authorized signature:
112.....t.,(124.-, _ State surcharge(12%of permit fee) _
'1,17g TOTAL PERMIT FEE
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Print name: 170/13 Q l'illyi- 4 ea-1,7 Date:7/g 1 I q This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
BEtuilding\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 ties_. Qty. Fee(ea) Tt141Square Footage: erliit Fee:
g
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 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 In' actions 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*. �'i 'v for Pin!E i 1.1,1:,°11.11 stailations
QuantiyFixture
by Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: CaPPed 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
-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 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"
0 Isometric or riser diagram is required for new buildings
-Car Wash Dram
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/Sery/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 beaid before the
Water Extractor p
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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