Permit (156) CITY OF TIGARD PLUMBING PERMIT
11
M��! COMMUNITY DEVELOPMENT Permit#: PLM2019-00375
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/19/2019
E fn�k R Parcel: 1 S 134C 601800
Jurisdiction: Tigard
Site address: 12130 SW SUMMER ST
Project: Lamb Subdivision: SUMMER HILLS PARK Lot: 21
Project Description: (2)sinks,(1)tub/shower, and(1)water closet for master bedroom and bathroom addition.
Contractor: OWNER Owner: LAMB, RICHARD PIERCE
RICHARD&JANNA MAE LAMB BOREN, JAN NA MAE MARTIN
12130 SW SUMMER ST. 12130 SW SUMMER ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 541-840-5537
541-840-5537
FAX:
FEES
Quantity Description Date Amount
2 ea Sink 09/19/2019 $50.04
Specifics: 1 ea Tub/Shower/Shower Pan 09/19/2019 $12.51
1 ea Water Closet 09/19/2019 $25.02
Type of Use: SF 1 12%State Surcharge- 09/19/2019 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.08
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 availab '' s1e rFi pection 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
i
City of Tigard EC E' "`J DateRece/Byved: ill//et 4,2_ Permit No.: �/Mi a,`Ci.��,)37s.
13125 SW Hall Blvd.,Tigard,OR 97223 9 nn Plan Review "L� I W /J
■ Phone: 503.718.2439 Fax: 503.598.1960 SEP 1. ZU19 Other Permit No.: ry r -(2)31:Yr
Date/By: !'I'�S'o�,u �/"
TIGARD Inspection Line: 503.639.4175
Date Read/BY Juris. ® See Page 2 for
Internet: www.tigard-or.gov r TIGARD
VI, . -. SI
N Notified/Method: Supplemental Informat
ion
:46.2-Lt`:.':: ' Y- .. *oRK BUILOWU ply"? a * ii --_J---,---:t--- .
.tea
❑New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY:OF:CONSIKOCTION SFR(1)bath _ 312.70
Fand 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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /7I3 ) ,. S.-um/kit/ Si-: Catch basin or area drain 18.76
City/State/ZIP: T-, a`d 7 Z Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: L.J I Project name: i�. Manufactured home utilities 50.03
Cross street/directions to job site: 12.4 SG..}--- ST 5 S ung ' S/ 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: �u!'�'I!�-tey' y///.5 /7 7/ - Lot no.: Z' Fixture or item:
Tax map/parcel no.: j 6/3�-c 0(806) Backflow preventer 31.27
1 -4:4t t`v t, , - Backwater valve 12.51
;•--;tea. I _.. r
" Clothes washer 25.02
afes/ 19#1 �. - 4l��avt-r09-r1
� � �� �� -. Dishwasher 25.02
/fg-�/ 7/614/'- ✓a Drinking fountain 25.02
Ejectors/sump 25.02
Et, ,"i o ° 3 4=j❑ TENANT Expansion tank 12.51
Name: Ods ,ev Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 24 30 Sive/...c 04fr it if St
Garbage disposal 25.02
City/State/ZIP: ! , 0v Be Q 1 ZZ 3 Hose bib 25.02
Phone:(4:V9//) 7"5-5 Fax:( ) Ice maker 12.51
r siii 0 , Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: /73Mta //UfY
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory . 2, 25.02
City/State/ZIP: Solar units(potable water) 62.54
(9!1 �.
Phone: 840-155 3 4 Fax::( ) Tui/shower/shower pan 12.51-
Urinal 25.02
E-mail: ",Ct vi vLicivr eP aeePC (,vt4l t t •�co K4 '
J r Water closet 25.02
t. ' * CTOR Water heater 37.52
Business name: �' I///&/Z Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal g-`7 rj 7
Minimum permit fee: $72.50
Phone:( ) Fax:( )
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) Go- f
Authorized signature:
,•:,-7 TOTAL PERMIT FEE Il ()r
Print name: y' Date: 7//pif 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:\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 Qty. Fee tea) Total Square Footage: PermitFee:
Footing drain-151 100' 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 ` luation- 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
Qthetr Inspections ori 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*. Plan . eview for -":;?f,.. Stallatlons ;w
r f,uantlty by Fixture Type Plan review is required for any of the following.
FixtureTypp for RePtaf l Please check all that apply.
Work Per onned: Caffed Added amu.
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 Thru 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" ick qr Riser Dieit44 11:::'
4>, 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