Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00015
T I C A R 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/09/2020
Parcel: 2S103DB02300
Jurisdiction: Tigard
Site address: 13455 SW GENESIS LOOP
Project: MAYHUGH Subdivision: GENESIS Lot: 17
Project Description: Replacing(2)tub/showers and(2)water closets.
Contractor: PARAMOUNT PLUMBING CO Owner: MAYHUGH FAMILY TRUST
7127 SE MABEL AVE BY MAYHUGH, TED&JANE TRS
MILWAUKIE, OR 97267 13455 SW GENESIS LOOP
TIGARD, OR 97223
PHONE: 503-239-7516 PHONE.
FAX:
FEES
Quantity Description Date Amount
2 ea Tub/Shower/Shower Pan 01/09/2020 $25.02
Specifics: 2 ea Water Closet 01/09/2020 $50.04
12%State Surcharge- 01/09/2020 $9.01
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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. ose ules a set forth in R 952-001-0010 through OAR 952-001-0090. You may� opy of the rules
or direct questions to OU ca ' g 503.2 .1987 or 1. . 344. ��
Issued By: Permittee Signature:
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 FOR OFFICE USE ONLY
City of Tigard ' " ' - Received / /
• 13125 S W Hall Blvd.,Tigard,OR 97223 Hate/By` ( F(� / �yi!/G//!7"� a!
Pl
Phone: 503.718.2439 Fax: 503.598.1960 an Review
Date By: Other Permit No.:
D
1 I t i A R I y Inspection Line: 503.639.4175 Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New nstruction El Demolition
For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family .dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-famil y wellin d SFR(2)bath 437.78
g ❑Commercial/industrial
❑Accessory building El Multi-familySFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: �f G�:7 SV C7�i✓CS�/ v ts .1.-,v
," Catch basin or area drain 18.76
Dry18.
6
City/State/ZIP: / p CV- Z Z Footing
1,leach line,or trench drain 2
J 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
r 17/ .c. o J tl DL) ",
��� /,. <~ S�/ tl vim`s4 V Dishwasher 25.02
Se T 2 1G 4,v .r.°t iVs S .e%S Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY . ",z ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
�r
Floor drain/floor sink hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker
12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Contact name:
Primer 12.51
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 a 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 2......, 25.02
Business name: .� r` Water heater 37.52
�iz/Pt oq,,i7 / /,tn.t/..1 Cc`
,
Water piping/DWV 56.29
Address: �-/)Z.14
- ,S�' , 'e G/ ,t_ Other: 25.02
City/State/ZIP: /Z 4G Y Oat r 2.1 C Z Subtotal
Phone:(S-`.ZJ) 0217- S"/ Fax:( ) Minimum permit fee: $72.50
CCB Lic.: y1 ��� 9-1/� Plan review (25%of permit fee)
�� .��' ` ��� Plu in Lic.no.: 2L G apt
State surcharge(12%of permit fee)
Authorized signature:� / TOTAL PERMIT FEE
Print name: ! /G�[ 4 J O C4/,,,re ...E Date:/,2,7 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:\BuildingU`ermits\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-I"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 Inspections or Fees Qty. Fee(ea) 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/M $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 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.
lacnrr/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 ❑El 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
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar 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:
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