Permit IL CITY OF TIGARD PLUMBING PERMIT
3 '' COMMUNITY DEVELOPMENT Permit#: PLM2020-00089
Date Issued: 02/27/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110DC90021
Jurisdiction: Tigard
Site address: 15695 SW 114TH CT 2
Project: Fountains at Summerfield Subdivision:TAINS AT SUMMERFIELD CONDO-PH. Lot: 2
Project Description: Replacing(1)clothes washer,(1)dishwasher,(1)garbage disposal,(1)hose bib,(1)sink, (2)lavatories, (2)tub
shower pans, (2)water closets,&(1)water heater.
Contractor: MY PLUMBER Owner: BROCK, PAUL W
PO BOX 87460 15695 SW 114TH CT#2
VANCOUVER,WA 98687 TIGARD, OR 97224
PHONE: 360-991-9991 PHONE: 503-332-5169
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 02/27/2020 $25.02
Specifics: 1 ea Dishwasher 02/27/2020 $25.02
1 ea Garbage Disposal 02/27/2020 $25.02
Type of Use: COM 1 ea Hose Bib 02/27/2020 $25.02
Class of Work: ALT 1 ea Sink 02/27/2020 $25.02
Type of Const: 2 ea Lavatories 02/27/2020 $50.04
Occupancy Grp: 2 ea Tub/Shower/Shower Pan 02/27/2020 $25.02
Stories: 2 ea Water Closet 02/27/2020 $50.04
1 ea Water Heater 02/27/2020 $37.52
1 12%State Surcharge- 02/27/2020 $34.53
Plumbing
Total $322.25
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:
v �17
Call 503.639.4175 by 7:00 a.m.for the next available inspectio ate.
This permit card shall be kept in a conspicuous place on the job site until com on 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
Received f
City of Tigard e j P LNq wxj
• 13125 SW Hari Blvd.,Ti Date B
NI . E Plan Review f,-` 6 /y((
Phone: W Hal Blvd. 5 1111ww Plan fty:Rev f/F/F "�' "rill/).
1 I GA A RD Inspection Line: 503.63 ]ry Date Ready/By: Juris: la See Page 2 Tor
Internet: www.tigard-or.gov .- 2. LU Notified/Method: Supplemental Information
TYPE OFVa2K nrE�� FEE* SCHEDULE
❑New construction CV ' L 1 U�i, For special information use checklist
1 I '71IIkJJJ Description Qty. I Ea. I Total
❑Addition/alteration/replacement 'Ayq W Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
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 ..) ) u. t i �i �Z.74, �� Catch basin or area drain 18.76
��/ 7 L.
C/FS Drywell,leach line,or trench drain 18.76
City/State/ZIP: (/ C C q Z z
Q S it Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: O� ' R'Oject naafi, b ;.11,U CYA-114"c4 W'4v1anufactured 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 Backwater valve 12.51
itr
Clothes washer I 25.02
/ �! - Dishwasher I 25.02
/ ,�/(c' t '- J c/Ai< -f I v Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal I 25.02
City/State/ZIP: Hose bib I- 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: (�G Medical gas(value:$ ) Page 2
�) Primer 12.51
Contact naitie: (4 1 ,-7 rs A2,-77 fC.N i?l 6-eS -. Roof drain(commercial) 12.51
g:*iddress: 16X /27O Sinlvbasin/lavatory _ 3 25.02
ICity/State/ZIP:.. LrG3y ,4 i D O le_ '7 7/4/0 Solar units(potable water) 62.54
Phone:(ram j) 3 32-S/to ? Fax::( ) Tub/shower/shower pan 2, 12.51
Urinal 25.02
E-matt (11C,`-7zL-g ,, ke )(1,1/4 C L. _
'c`• . 1 _
/ Water closet 2 25.02
CONTRACTOR Water heater ( 37.52
Ousinessname: y PLtt-rq_P@Zi Water piping/DWV 56.29
Address: 0 t3D-'„,c Y 7.1 6,O Other: 25.02
City/State/ZIP: V4)✓c Ot,,`y 1/3.A- Subtotal
Phone:(30 i / - /Dv Fax:( ) // (> Minimum permit fee: $72.50
CCB Lie.: 2�G I �, Plumbing Lic.no.: t/7/ Plan review (25%of permit fee)
I J / (1 State surcharge(12%of permit fee)
`Authorized sign tore: 7 - TOTAL PERMIT FEE
` �//, � (� �n�/�/1 This permit application expires if a permit is not obtained within 180 days
Print name: (� �r f{� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pumits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WPB)
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 2,001 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- Ist 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
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
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-I/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
Baptistry/Font ElAny 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 ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El 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" Isometric or Riser Diagram
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 -Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -L avBar 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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