Permit (2) CITY OF TIGARD PLUMBING PERMIT
1111
COMMUNITY DEVELOPMENT Permit#: PLM2020-00014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/09/2020
Parcel: 2S114BB20800
Jurisdiction: Tigard
Site address: 10285 SW KENT CT
Project: BERUBE Subdivision: RIVERVIEW ESTATES NO.2 Lot: 52
Project Description: Relocating(2)sinks, (1)shower,and re-installing(1)water closet for bathroom remodel.
Contractor: GLS PLUMBING Owner: BERUBE, JONATHAN &ALYSHA
1615 BREWERY GRADE 10285 SW KENT CT
DALLES, OR 97058 TIGARD, OR 97224
PHONE: 541-508-8645 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Lavatories 01/09/2020 $50.04
Specifics: 1 ea Tub/Shower/Shower Pan 01/09/2020 $12.51
1 ea Water Closet 01/09/2020 $25.02
Type of Use: SF 1 12%State Surcharge- 01/09/2020 $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 952-001-0010through 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.
� 7 >
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available ins ion 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 RECEIVE , FOR OFFICE USE ONLY
Cityof Tigard(� Received
,� g p Date/By: ! Permit No.: q i, f
• 13125 SW Hall Blvd.,Tigard,OR 97223 JAN 9 2020 Plan Review
9� �o.: � ``6
Phone: 503.7182439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 CITY OF TI G A P r Date Ready/By: Avis: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
IL-v!IV\I L/I VIQ.. II,JIV ��
TYPE OF WORK v FEE* SCHEDULE
For special information use checklist.❑New construction El Demolition
Description I Qty. I Ea, I Total
I]Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
7i-' 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:/0,2 8c 5(,) 4c47. (1 Catch basin or area drain 18.76
�j� Drywell,leach line,or trench drain 18.76
City/State/ZIP:
/ I'v, Of
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 8-r_.4ck (a-V.- 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
F` 2, , /erg /k9/`.7CIf Yla./e_�/j/./,/ 54e/ (2'/✓e 5 Dishwasher 25.02
4/7O1I� kV a/4art., J/nc/G1 /414 2 Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
Name: ��� v 04' 4tSL 4. Floorelsewercap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib
25.02
Phone:( ) Fax:( ) lce maker 12.51
0 APPMCANTCONTACT PERSON Interceptor/grease trap 25.02
Business name: S /�/„?bf /W Medical gas(value:$_) Page 2
Contact name:
4,0v e. .S7u Primer 12.51
Roof drain(commercial) 12.51
Address:j /S (3([-1 let, Jr n p Sink/basin/lavatory a 25.02 5-i,v+1
City/State/ZIP: -A t a./e 5 0( . 9 / 0�- O Solar units(potable water) 62.54
Phone:(S//) 6"013- g 1,NS Fax::( ) Tub/shower/shower pan / 12.51 (I-"f
E-mail:y 6 'J b i . / -, Urinal 25.02
C&1TRACTOR Water closet 25.02 lla
/ Water heater 37.52
Business name:,(1� Gbh,L Water i m DWV 56.29
UI PP g/
Address:/(,j( /9�.c��ic/I � i" r� p Other: 25.02
City/State/ZIP: f, /.J f 06 • q / 5- O Subtotal -"7.57
Phone:(ej�y/)SeC j- ? t I ( Fax:( ) Minimum pennit fee: $72.50
.r(� Plan review (25%of permit fee)
CCB Lic.d/q/a3 Plumbing Lic.no.:� 11
��/ State surcharge(12%of pernit fee) to,S I
Authorized signature:� „n TOTAL PERMIT FEE 4 i--ag
Print name:/ rn_ L S Pv / Dater ci,a v This permit application expires if a permit is not obtained within 180 days
�` �l after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board.
I:\BuildingTermits'PLMU-PermitApp.doe 10/01/09 440-4616T(I t/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
Footing drain-each additional 100' 37.52 2, to 3,600 $169.69
3,60101 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 fast$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
❑ 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
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3• Isometric or Riser Diagram
4" ❑ 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 Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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