Permit (2) R CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit#: PLM2019 00431
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2019
Parcel: 2S112BB04700
Jurisdiction: Tigard
Site address: 14145 SW FANNO CREEK DR
Project: RODERICK Subdivision: COLONY CREEK ESTATES NO.2 Lot: 30
Project Description: Shower pan replacement.
Contractor: ROSE CITY PLUMBING Owner: RODERICK, JOHN D &
4734 N MICHIGAN AVE RODERICK, MELISSA A
PORTLAND, OR 97217 14145 SW FANNO CREEK CT
TIGARD, OR 97224
PHONE: 503-936-5618 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 10/24/2019 $12.51
Specifics: 1 12%State Surcharge- 10/24/2019 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 10/24/2019 $59.99
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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: �)J�{/�/�/ry �'-"--.0. _fes}
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
City of Tigard # � '"` � �``� Received
- � / " Date/By.. ''(( �g c Permit No.: I-
14
Ill 13125 SW Hall Blvd.,Tigard,OR 13"" ,,..'7.,..f4
y' /v/� i ��/- ,��rv,av���� �(��
Plan Review
Phone: 503.718.2439 Fax: 503.598.1269_ Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 ULT 24 2019
T I G A R D c. Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov .,
{ Notified/Method: , Supplemental Information
TYPE OF WU ~ G `� 'O� ,9 FEE* SCHEDULE
For special information use checklist
❑New construction ❑Demolition
Description Qty. 1 Ea. 1 Total
ldition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
// f y dwellin CATEGORY OF CONSTRUCTION SFR(1)bath 312.70(
(/ and 2-famil SFR 2 bath 437.78
g ❑Commercial/industrial )
❑Accessory building 0 Multi-family SFR(3)bath 500.32
0 Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler p� ( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /t f/t f 5 SW F Catch basin or area drain 18.76
ailfzo CY/a k
City/State/ZIP: ---77b 4y� 0 ' '7��y
Drywell,leach line,or trench drain 18.76
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.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK • Backwater valve 12.51
Clothes washer 25.02
Silo;. :c- pC,Y) Y'PpIacP✓rL.e"Ti Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap25.02
Name: jo Me l,'55,-.., kfle�^,'eLoe
Floor drain/floor sink/hub 25.02
Address: /(flifs- , &tinO Ceef. Com-
Garbage disposal 25.02
City/State/ZIP: 77;9 ei,..Dt (2A f3 7-2..1 '1 Hose bib 25.02
Phone:(9 77) 7 7 7-- -Ss'S Fax:( / ) Ice maker 12.51
g APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
.,.ot e: . c./� , ,
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 1 12.51 /a, „5-7
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:R se if., /P44,/r2 Z�
J ^/ �2.-../„.42 n Water piping/DWV 56.29
Address: 5t734 /V �iC�l�`moi je9 , Other: 25.02
City/State/ZIP: iiY�lltd2d v 67.2-e/7 Subtotal /J.,S J
Phone:(s03) 936 -'540 If Fax:( ) Minimum permit fee: $72.50 7�.S®
/ 01 r /7 .,2„).../ Plan review (25%of permit fee)
CCB Lic.: D�J Plumbing Lic.no.:
Lt)� State surcharge(12%of permit fee) 7 0
Authorized signature:
7 !`
"�!� i�e �G�/ � ' TOTAL PERMIT FEE S`. j
Print name: �L�S Date: This permit application expires if a permit is not obtained within 180 days
t2�DF.eLe.� 1a��5/ 9 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pemits\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(ea) Total Square Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52
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
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.
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*. 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
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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ 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
L.
Building Permit Application
Site Workr(mz OFFICE I si:U. ,I
Cityof Tigard Received P
g Date/8 : (c' y (7
IIt 13125 SW Hall Blvd.,Tigard,OR 97 ) D Plan Review Other Permit:S Phone: 503.718.2439 Fax: 503.598.1'1 DateB
Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
TIGAKll
Internet www.tigard-or.gov OCT 2 8 2019 Notified/Method: Supplemental Information
TYPE Of,W li 1 O „ REQUIRED D4TA:1-AND 2-FAMILY DWELLING
New construction 0 Demoli'tlon Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
t 0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
w work indicated on this application.
`� .=,..,'="1`„, �CATEORY;C1F cOSTRIC�� t,
'1and 2-family dwelling jai ommercial/industrial Valuation: $
❑Accessory building 0 Multi-family
-- Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
,h ;IOB SITE INFORMATION.AIYAr IA)CA.; O. ,, ` : - yr,,,,',,,,,! Total number of floors:
6 Job site address: ' New dwelling area: square feet
r
City/State/ZIP: , / / ,:w — Garage/carport area: square feet
Suite/bldg./apt.no.: I. Project nam ed c Covered porch area: square feet
Cross street/directions to job site: 60,41 7 d. Deck area: square feet
Other structure area: square feet
:I1EQUIREDHATA:COMMERCIAL-LSE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION'OF "WORK work indicated on this application.
i/1 C ./-1 t(4D j r 1 Valuation: $
f Existing building area: square feet
1-+ 'S'
New buildingarea: square feet
e s uar
.'.- 1-1.) ("Ji/a.- AA 4Y),..±1‘ . Os) C1rN P(;),..-rieri
PROPERTY`OWNER 4 F ❑,;TENANT ., Number of stories:
Name: 0 ;p1 ; ,. .S c +q ; Type of construction:
O
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New
:°1 APPLICA,4T, CONTACT FTRSor . . NOTICE.
Business name of (+ ,.( t e- f'` r /f"j All contractors and subcontractors are required to be
licContact name: f~{ r- "'1 1 (,; under ORSd with the and mayregon Construction Ce licensedrs
Board
J under 701 may be required to be licensed in the
Address! -' �, 17) ,'' ,r')- f C,.0 jurisdiction in which work is being performed.If the
/ applicant is exempt from licensing,the following reasons
City/State/ZIP: / ( apply:
Phone:66 ),,,,53,54.11/f5---
t .1' Fax:: Li ""
E-maill G.t CtA et.cal Li Z 0 10 *DAl ' G / +1 .,4"
CONTRAC `OR k
Business name: I I i I 'BUR%DING,PERMIT FEES*
" (Pleaserelerto'feescitedid`e)
Address:l 1 I 1
Structural plan review fee(or deposit):
City/State/ZIP: c k p 1
ix I Fax:( ) 1t I 1 FLS plan review fee(if applicable):
!
Phone:( ) Total fees due upon application:
CCB lic.: .. } _ 3""
Amount received:
Authorized signature �� , / I This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:1. Li 1,- LI-C (1"--‘7/ Date:J a �i I c7
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613(11/02/COM/WEB)