Permit Support Document (2) INCITY OF TIGARD PLUMBING PERMIT
i " COMMUNITY DEVELOPMENT ,,, /���
Permit#: PLM2018 00020
Tt , R.L) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 h-®_ Date Issued: 01/16/2018
Parcel: 2S 102CA00908
Jurisdiction: Tigard
Site address: 13440 SW ASH AVE
Project: Stockberger Subdivision: VILLAGE GLENN Lot: 8
Project Description: Replace shower,drain location and shower valve. 1/17/18:REPRINT to add(1)shower pan.
Contractor: OWNER Owner: STOCKBERGER, SARAH
WETZEL, NATHAN
13440 SW ASH AVE
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Tub/Shower/Shower Pan 01/16/2018 $25.02
Specifics:, 47 Minimum Fee Adjustment- 01/16/2018 $47.48
Plumbing
Type of Use: SF g 12%State Surcharge- 01/16/2018 $8.70
Class of Work: ALT Plumbing
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: /,/ i7 lir - Permittee Signature: l
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.
Plumbin Permit A licatio ,. ,---
Building Fixtures , 1 , 11 -1 f
Foa OFFICE LSE ONLY
City of Tigard IAN 1 7 2 018 Received
IIIII
m 13125 SW Hall Blvd.,Tigard,OR 97223_ Date/By: ( / Permit No.: �o/
II Plan Review �� !O
G 00zo
Phone: 503.718.2439 Fax: 503.591Y
61 b P ". Date/By:
Other Permit No.:Ins
Inspection Line: 503.639 4175 I� ,� r ,TQ� (TIGARD Date Read/BY J°da: I See
Page 2 forInternet www.tigard-or.gov Notified/Method: Supplemental
Information
. .... TYPE OF V1'ORK " FEE" SCHEDYILE
0 New construction 0 Demolition For special information use checklist
(X]Addition/alteration/replacement 0 Other: Description Qty. Ea. Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
' CATRGORY OF CONSTRUCTION ' % SFR(1)bath 312.70
g] 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ?74 1, C��ki 4; 41 (� r Catch basin or area drain 18 76
Ld,
City/State/ZIP �� a r .y7 Drywell,leach line,or trench drain 18.76
1' :ai �l 7 Footing drain(no.linear ft.:
Suite/bldg./apt.no.: Project name: -) Page 2
Manufactured home utilities 50.03
Cross street/directions to job site:
C r1 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
. 1 ''r -,,„,D51-45Y174,."7.,..,,, ,,,,,,",4A.,.. ,;;,,,..,..,,., , . , .4 4 Backwater valve 12.51
`" r v IS t, i Clothes washer
7.., 25.02
} �X k1� \vL` r75 4 ®� Dishwasher 25.02
U)t1\iit, kl...V 31 1 ' 1`A I x• ''1421 ,^r6 �y/S®/A/6- - Drinking fountain 25.02
Yr-0.�uti?�. `iNi.\0,yts` ,'rAl'si i 1 1 t ✓j.iriv7 / +'"y!7-- Ejectors/sump 25.02
p� PI OI@Eltl(Y OW1NER TEN " Expansion tank
V%
` 12.51
e;'7,1 rt � l):.I t }G s rFixture/sewer cap 25.02
Nam
Address: t4 Floor drain/floor sink/hub 25.02
�'v �,,v V v Vt
City/State/ZIP: -i, \ p Garbage disposal 25.02
4/v" t F ') � Hose bib 25.02
Phone:( ) �•1
( � Q 4 �j� Fax:( ) Ice maker
1 A1,PPd ICANT 4'. 12.51
❑ CONTACT`PERSON: Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Address: Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:
Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan
"47 12.51
E-mail: Urinal 25.02
Water closet
.yONTRACTORs: f � 25.02
Business name: Water heater 37.52
Water piping/DWV 56.29
Address:
Other: 25.02
City/State/ZIP:
Subtotal
Minimum permit fee: $72.50
Phone:( ) Fax:( )
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
Authorized signature: ./ „I State surcharge(12%of permit fee)
�� �� �� TOTAL PERMIT FEE
Print name: ` This permitapplication expires
�,V`y t c��D, jl ! ti Date: +1 a lication if a permit is not obtained within 180 days
`rJ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PemitApp.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:
qty: F*e(ea) T �` 'Square Footage: ., 'er t` „
�t�T,��ttes �� _
Footing drain-l'100' 50.03 0 to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 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
each additional$100.00 or fraction thereof,to
Other Inspections or Fees " ree e9 TOt1/1 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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr 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*. „ , p1ai Ren ew2for Plumbing Instal at two,, fa,,
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ ` Please check all that apply.
Any
WorkPerformed:
Capped Added Relocate ❑ new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 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" , . ISolilie r C r Wier Din/4M ' ,, o
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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13440 SW ASH AVE, TIGARD, OR, 97223 January 23, 2019 at
1 :05:04 PM
Record Type: Record ID:
Residential - Plumbing PLM2018-00020
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor