Permit (53) 111CITY OF TIGARD PLUMBING PERMIT
!PI ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00307
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2019
Parcel: 2S103DB00100
Jurisdiction: Tigard
Site address: 13030 SW 115TH AVE
Project: BOROW Subdivision: None Lot:
Project Description: 120 ft.of water service from new meter to existing home and 300 ft. of water service from new meter through a
utility easement to a new home.
Contractor: D& F PLUMBING Owner: BOROW, HARLAN S
4636 N ALBINA AVE PACIFIC EVERGREEN HOMES LLC
PORTLAND, OR 97217 13030 SW 115TH AVE
TIGARD, OR 97223
PHONE: 503-282-0993 PHONE:
FAX: 503-288-0604
FEES
Quantity Description Date Amount
420 If Water Service 08/01/2019 $212.62
Specifics: 1 12%State Surcharge- 08/01/2019 $25.51
Plumbing
Type of Use: SF
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, 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 952-001-00.0. 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: 4gfA4 �
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 iaeSm E ivr;7,f FOR OFFICE USE ONLY
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City of Tigard Received
111111 13125 SW Hall Blvd.,Tigard,OR 97223 AUGDate/By: t `� PennitNo.: yn/M 7a#G
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F AG 2019 Plan Review / / J `�' 'Ow / �
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date/By:
Internet: Line:gard-or.gov.41 `cry "-� 9 y '-�vI Date Ready/By: hilt_ ® See entalage 2 for
Notified/Method: j�T- Supplemental Information
TYPE OF WORT �':. FEE* SCHEDULE
For special information use checklist.
❑New construction ❑Demolition
EjSraition/alteration/replacement ❑Other: Description Qty. Ea. Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
g61-:'and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
0 Accessory building ❑Multi-family SFR(3)bath 500.32
0 Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: . ? Catch basin or area drain 18.76
City/State/ZIP: --Frid t 0 0_ 4 7-- Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: r
1 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 ILMIN
Subdivision: Lot no.:
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
Clothes washer 25.02
420 LARz-I`i✓ ;-c✓ -fyeAry% /`iG7`L'' Dishwasher
y .1 25.02
Iy/
cX 1 �`�� `W"1 J?0) '. W^�/Z� Drinking fountain 25.02
I -:- `47,.: r 'r , G Ejectors/sump ■ 25.02
PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: t Fixture/sewer cap 25.02
Address: (30.30 5(,u ;t�- Axle_ Floor gedrdisposa sink/hub 25.02
City/State7ZIP: til 5�r-C1 0 t ZZ 3
Garbage disposal 25.02
Hose bib 25.02
Phone:(° ) 'j .-t+ Fax:( ) Ice maker
12.51
'- _ 'PLICANT ri5. CONTACT PERSON Interceptor/grease trap 25.02
Business name: � Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Address:
Roof drain(commercial) 12.51
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
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: a;; .. ,rte• (t�v^�t
2 /7 t r Water piping/DWv 56.29
Address: 4/6I 7 K' j y�� e
Other: 25.02
City/State/ZIP: Ate
Subtotal
Phone:(' 7)) 5-3 to-fa-55- Fax:( ) Minimum permit fee: $72.50
�Z3?� Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee) i
Authorized signatur y'
(�� TOTAL PERMIT FE DA
Print name: -1x� cd14.) Date: /i f t 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.
I:Buitdmg Permits PLMU-PermitApp doe 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 Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-15'100' 50.03 0 to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 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' /1 _ 37.52 /57),or Valuation: Permit Fee:
Storm&Rain Drain-1st 100' I 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
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.
90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal: ,i R.J
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 Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate ❑ 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain . Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
-3' Isometric or Riser Diagram
4"
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
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:
13030 SW 115TH AVE, TIGARD, OR, 97223 August 2, 2019 at
10:34:04 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00307
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Water service from new meter location to existing house- approved with test.
Violation Summary:
Inspector Contractor