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Permit CITY OF TIGARD PLUMBING PERMIT .111 COMMUNITY DEVELOPMENT Permit#: PLM2020-00139 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/07/2020 Parcel: 2S111CD00500 Jurisdiction: Tigard Site address: 9835 SW DURHAM RD Project: PERENBOOM Subdivision: ALDERBROOK FARM Lot: 21 Project Description: Adding(1)additional washing machine. Contractor: OWNER Owner: PERENBOOM, SUSANNA SUZANNA PERENBOOM 9835 SW DURHAM RD 9839 SW DURHAM RD TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503-459-7425 PHONE: 503-459-7425 FAX: FEES Quantity Description Date Amount ea Clothes Washer 04/02/2020 $25.02 Specifics: 1 12%State Surcharge- 04/02/2020 $8.70 Plumbing Type of Use: SF 47 ea Minimum Fee Adjustment- 04/02/2020 $47.48 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: / 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 Applieatiod�EC I\jED Building Fixtures MAR 3 0 2020 POI( OFFICE 1 SF.. opt City of Tigard Received Vi r�r DatelBy: P 13125 SW Hall Blvd.,Tigard,OR 97223 iF'i� �`(/ �4v V r�L/`•3 Plan Rcvicw ■ Phone: 503.718.2439 Fax: 503.598.k960 ,t,,C DIVISION DatdBy: Other Permit No.: I.I \I.1 I} Inspection Line: 503.639.4175 Date Ready/By. Suds' El See Page 2 far Internet www.tigard-or.gov Natifie&Xleihod: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist �Q Addi[ion/alterationlreplacement ❑Other: Description ( Qty. I Ea. I Total Y-" 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 dwellin SFR(2)bath 437.78 g ❑Commercial/industrial SFR(3)bath 500.32 0 Accessory building 0 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: q 5-7-)5 5 LA) -9,.1 C mN2.A, Catch basin or area drain 18.76 Drywall,leach line,or trench drain 18.76 City/State/ZIP:T & ©v_ ci`7�'L,(,t Footing drain(no.linear ft.:� Paget Suite/bldg./apt.no.: Project name:l 1 __�l t �Af3�" U)Y��v�� Manufactured home utilities 50.03 Cross street/directions to job site: �J Manholes 18.76 0 ki) (At t--ham r“- 5‘.3 D V I m. .1, 5 iA) cl`3 Rain drain connector 18.76 Sanitary sewer(no.linear R:_) Page 2 Storm sewer(no.linear ft.: ) Page 2 �iRR Water service(no.linear ft.: ) Page 2 Subdivision: 4 �0;€00c- x To_.g. Z yv, I Lot no.: , Fixture or item: Tax map/parcel no.:-9_05aA q 4)2.. Backflow preventer 31.27 Backwater valve 12.51 Clothes washer 1 25.02 I-t ` ..ek. Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWNF4t, J, 0 TENANT Expansion tank 12.51 Name: 5Qocanne. V o� Fixturelsewercap 25)ArN .02 Address: 9 T)'1 5 U.) `-)C�(' l2 l�, Floor geai spoor sink/hub 25.02 `J tfl� disposalGarbage 25.02 City/State/ZlP. i� 17 t Q a(i Hose bib 25.02 Phone:(60-5)445�t-7q'.j.e 1` tFax:( ) Ice maker 12.51 ❑ APPLICANT kkCONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$_) Page 2 Primer 12.51 Contact name:5( . '''' VI(A� Roof drain(commercial) 12.51 a Address: l 43 S� ` )uc ' wvl' Sink/basin/lavatory 25.02 City/State/ZIP:-1-). A. 1 1/O- A/ ZZ(,( Solar units(potable water) 62.54 Phone:(5>-y�),) if5 ..`7 4 25 Fax::( ) Tub/shower/shower pan 12.51 E-mail: 546510%l Ail4-4 14/1--.Y o-1, ` /GW aA-- Urinal 25.02 CONTRACTOR heater Water et 25.02 Water hea 37.52 Business name: Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 12,.60 Plan review(25%of permit fee) 14e`?) CCB Lie.: Plumbing Lie.no.: 0 State surcharge(12%of permit fee) , Authorized signature: o ��'"'^^ �,j1-� TOTAL PERMIT FEE 7 q ,`ys Print name:5 t^ 7e��, Date: 1/G 2 This0 permit application expires if a permit is not obtained within 190 days 7Y after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. I:1Building\PerranslPLMU-PematApp.doc 10/01/09 440.4616r(10M/COM/W€13) • • 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-1st 100' 6254 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 Otherht�� '� ` Fee ea,� .v3oal each additional$100,00 or fraction thereof,to 3p+ ioh 'id>Cee9 ( 7 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—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 FixtureType 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 Ca Wash: -Each ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: -Commercial ❑ Any multipurpose fire Sprinkler system. Domestic El 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" Oinetiti bP er 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: -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 Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: f:1Building\Permits WPLMF_PermitApp.doc 08/04/2011 2