Permit ,t CITY OF TIGARD PLUMBING PERMIT
III ' COMMUNITY DEVELOPMENT ; I Permit#: PLM2016-00031
w�
�!!!�ff / Date Issued: 01/27/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718. �� Parcel: 1S134ACO2634
Jurisdiction: Tigard
Site address: 11075 COTTONWOOD LN
Project: TRUNE Subdivision: ENGLEWOOD NO.3 Lot: 191
Project Description: Moving(1)clothes washer and(1)utility sink.3/8/16,REPRINTED to replace tub with shower.,
Contractor: BLUE LINE PLUMBING INC Owner: TRUNE, DENNIS R AND TARA L
1820 SW WYNNWOOD AVE 11075 SW COTTONWOOD LN
PORTLAND, OR 97225 TIGARD, OR 97223
PHONE: 503-706-0091 PHONE:
FAX: 503-644-7373
FEES
Quantity Description Date Amount
1 ea Clothes Washer 01/27/2016 $25.02
Specifics: 1 ea Sink 01/27/2016 $25.02
1 ea Tub/Shower/Shower Pan 01/27/2016 $12.51
Type of Use: SF 10 Minimum Fee Adjustment- 01/27/2016 $9.95
Class of Work: ALT Plumbing
Type of Const: 45 Misc Administration Fee 03/08/2016 $45.00
Occupancy Grp: g 12%State Surcharge- 01/27/2016 $8.70
Stories: Plumbing(manual)
Total $126.20
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 quest• o ` NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ' Permittee Signature:
r
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.
11um in pt A,DplieAtlCEIi' iimirill+
Building Fixtures
City of Tigardgli
Tua+ved 3loPernik No.: �/�- 3
13125 SW Hall Blvd.,Tigard,OR 9716,0 ' flan Review Other permit Na:
Phone: 503.639.4171 Foe 503.598.t960 i]rw7'fy
inspection Linc 503.639.4115 t]nee RotadyAly hair: El See Page 3 ter
CITY Of i>�llt�ltil Supplemental totem: aww.ti d to t+laOUiod/MelMod:
Bar ...- -.
For avoid infonrwlialse clitatlist
p Naw construction ❑Demolititm ..- Dom,vgea sty. Fa Taal
in Addkion/alteration/replaccmont 0 Other New 1.2-fanll,v dwellings(includes 100 Q.for each utility,connection)
O!: '
SFR(1)beth ' 312.70
SFR(2)both 437.78
_-and 2.1ilmily dwelling ❑Commerci i/indushial .r
Sly(3)bath + 50032
[]Accessory building In Multi-family ..� --.. .Bach additionid tttWulkitehon 25.02
0 ivinater builder d Other FW *nide;( s4.It) _, Page 2 _ _
' ' • :30s inn,INPORMA!IION•Alm LOCATION Sit ►
Catch Wein of area drain -T- 18.76
Job sites address: is7 S 5.W. e, Taj W D.2.. 1/v.
Drywe11,leach line,or trench drain 18.76
City/State/ZIP: `1 -__-.. Fooling drain(no.linear ft.:____) _ Per 2
Suitt/bldg./apt no.: Project name: --- Manufactured homeutilities 50.03
Cross street/directions to job site: - Manholes , 18,76
Rain drain connector _ 18.76
-- Sanitary sewer(no.linear R.:,_.) Page 2
- -- Storm sewer(no.linear R.:__„_) Page 2
,._ Water melee(no.linear ft.:___,) Page 2
....
Subdivision: La•ns•• - P'ietut Ire
Tax map/parcel no.: Backflow prevents? .. 31.27
�.�.
---- Backwaterwlve 12.51
lila lrKlltl" ' tI
l! � iG. _Clothes washer 25.02
r -. Mahe/other 25.02
Drinking f'amtein 25.02
7c7 D -re.,-5-79E1/.0-// OC )' Ejectors/rump 25.02
0� - ;••E2 rtrwrr Expansion tank _ 12.51
Alt-. � , -.- Fittrn /sewer cap 25,02
11 Name: ,V - -'
Floor diainNloor sink/hub 25.02
Address: _5796Z-
-.-. -- Garbage disposal 25.02
Citadel/ZIP:
13osa bib 25.02
Phew:( ) . Fax:( ) Ica milker 12.51
. a`,titt art.- ' 7:•..,,....?..,''.,
.,�,,•,' "1:1' .Maori .. . Interoaptor/gr trap 25.02
Business ntttruc Medical gag(value:S ) Page 2
..... .... '-' .-.�... Primer 12.51
Comet name:
---.-.. , Roof drain(commercial) 12.51
Address:
�,•--- Sink/twin/lavatory 25.02
Cit'/State/ZIP: Solar units(potable water) 62,54
Phc nc:( ) Fax::( ) 7tehi warhhower pan / 12.51
E nRil: �^ -- Urinal 25.02
-_: .�..
• 1 Water clued 25.02 W
.0 .-. .....\-- • • Water bacon 37.52
Smitten tame: r u_ Li , _ ) Water piping/DWV �- 56.29
Mimic ' i S Ikiap' t __.. Other: 25.02
City�l9tate/ZIP: �r . ' „ /✓7 C 2 Subtotal
Phone:(S 4) 706 t 9i//` Fax:( ) ___ _ Minimum permlt(cc: sn.50
Plan review (25+t,of permit uta)
CC13 1_... /_'"11/3.20 Lia no.: �
/'71 �3 Z ��z- State surcharge(tax of perm+t
Authorized signature: 9A------- TOTAL PERMIT PEE
Ert name: r 0 „..fie--a09 Date: -4-1 Tills parotid mikados tatairssir a penia b let obtained wkMn in days
.. �?_� mikados Ohm It has base accepted as complete.
*Pee methodology us by Tit-Comity Building Industry Service>3onrd,
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00031
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/27/2016
Parcel: 1 S134ACO2634
Jurisdiction: Tigard
Site address: 11075 COTTONWOOD LN
Project: TRUNE Subdivision: ENGLEWOOD NO.3 Lot: 191
Project Description: Moving(1)clothes washer and(1)utility sink.
Contractor: BLUE LINE PLUMBING INC Owner: TRUNE, DENNIS R AND TARA L
1820 SW WYNNWOOD AVE 11075 SW COTTONWOOD LN
PORTLAND, OR 97225 TIGARD, OR 97223
PHONE: 503-706-0091 PHONE:
FAX: 503-644-7373
FEES
Quantity Description Date Amount
1 ea Clothes Washer 01/27/2016 $25.02
Specifics: 1 ea Sink 01/27/2016 $25.02
1 12%State Surcharge- 01/27/2016 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 01/27/2016 $22.46
Type of Const: Plumbing
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 Application
Building Fixtureslots WIL
r. Received
City of Tigard : & > �4 Date/By: �? ' Permit No.: y7
13125 SW Hall Blvd.,Tigard,O ,9 223 h� �� X Plan Revie
wl
i Phone: 503.718.2439 Fax: 503.598.196�� ' Date/B Other Permit No.:
F � y:
Inspection Line: 503.639.4175 sf nom' Date Ready/By: funs: ® See Page 2 for
Internet: www.tigard-or.gov _A11(
N Notified/Method: Supplemental Information
., „-
❑New construction Demolition For special information use checklist
Description Qty. I Ea. Total
Ri Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(I)bath 312.70
s ..,.
�I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
kff T p1V�f 7CATI � Site utilities:
t
-r+-+
Job site address: Catch basin or area drain 18.76
Av x J '7 j J
Drywell,leach line,or trench drain 18.76
City/State/ZIP: �;
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 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 It.:_) Page 2
Water service(no.linear ft.:,) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
_ 4 (" Clothes washer 25.02
hove "'A r -1 L U T� -'��� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
x.:
Fixture/sewer cap 25.02
Name: M I,(,� - 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
A ', Interceptor/grease trap 25.02
.x ..
v�
Business name:
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
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 12.51
E-mail: Urinal 25.02
Water closet 25.02
Water heater 37.52
Business name: � ;� , j Water piping/DW V 56.29
Address:
/ OFT? P\j Other: 25.02
City/State/ZIP: �r_� Subtotal
Phone:( Fax:( ) Minimum permit fee: $72.50 '7
Plan review (25%of permit fee) -'
CCB Lic.: �� Plumbing Lic.no.: PP4.p State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE 1.
Print name: �" Date: ! /- 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.
L,BuildinglPermits?LMU-PermitApp.doc 1001,09 440-4616T(I 0,02,COM'WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
feel... Total` �. bAta' e: I Pertt1t " x
Footing drain-0 100' 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-1 st 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 �.
Storm&Rain Drain-1st 100 62.54 g,"
$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
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-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*. �llll ril'W 1' ulrllii�i. h 47
Quantity by tvixtnre Type Plan review is required for any of the following.
Fixture Type for; Replace/ Please check all that apply.
Workrerforme&_ Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
ElCar Wash: -Each Stall New exterior plumbing site utilities for any complex structure
-Drive tall as defined in OAR918-780-0040.
F-1Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic El Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye y Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
31'
-
-Car Wash Drain ElIsometric or riser diagram is required for new buildings
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refri .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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:ABuilding\Permits\PLMF PermitApp.doc 08/04/2011 2