Permit CITY OF TIGARD PLUMBING PERMIT
11
II . COMMUNITY DEVELOPMENT Permit#: PLM2016-00109
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2016
Parcel: 2S 115AA09000
Jurisdiction: Tigard
Site address: 10727 SW TITAN LN
Project: McDonald Subdivision: BERKLEY ESTATES Lot: 22
Project Description: (1)laundry tray in garage.
Contractor: M J'S PLUMBING Owner: MACDONALD, MARILYN C
PO BOX 18230 SPEEDIE,WILLIAM JOSEPH
PORTLAND, OR 97218 10727 SW TITAN LN
TIGARD, OR 97224
PHONE:
PHONE: 503-261-9155
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 03/03/2016 $25.02
Specifics: 1 12%State Surcharge- 03/03/2016 $8.70
Plumbing
Type of Use: SF 47 ea Minimum Fee Adjustment- 03/03/2016 $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: e„......----7 'tee Signature:
j
7g3-.
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.
L_
Plumbing Permit Application
Building Fixtures �o /
City of Tigard ` Date/Bed 3 3 �td Permit No.:/ �O1 --ooioe
13125 SW Hall Blvd.,Tiga � r y'
I ! Plan Review n-
Phone: 503.718.2439 Fa 98.1960 3 �Q� Date/By: Other Permit No.: vci2.1�0'-GLY.1(,l/'
Inspection Line: 503.639.4175 ��yy Date Read /B loris: ® Beefs Page 2 forr4 '{
I I t� ,It n Internet: www.tigard-or.gov ���� G;F� y o _ g
Notified/Method: Supplemental Information
.'';0''-:,'„ 3i`i ,+�.y.t, ,cTvtYer. 5. ,,: ',=.5v.,s-if.�..4",4 . .':7. .s .d�' ,'€ ,y l't r 1,t'- s, , � s E. -;.,,,4-„. .A
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❑New construction 11 x1 olition For special information use checklist.
Description I Qty. I Ea. I Total
171 Addition/alteration/replacement 0 Other: New l-2-family dwellings(includes 100 ft.for each utility connection)
i ... ,9 *�,,af' . -, ' t.i t 1:01 t -�, SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑ Master builder�� 0 Other: _ Fire sprinkler( sq.ft.) Page 2
4 .15`P'. .-4 t° .. ., � 4. . �' -ii'''' . Site utilities:
Job site address: l0 7a 9 566 TZ`,%C'L Catch basin or area drain 18.76
City/State/ZIP: 7,-,,,,,,,, �.�c . a a-T FoDroting
d ainh line,ne trench drain 1 Page 2
9 Footing drain(no.linear ft.:_) 2
Suite/bldg./apt.no.: Project name: /�/ n
(/f�GC 014/.E/1 Manufactured home utilities 50.03
Cross street/directions to job site: / 23,-* Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water serviceno.linear ft.: ) Page 2
( -
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
(����wa`". a �w , ,, .;"r r ._ '+. �' Backwater valve 12.51
r��°,," ',Ry's u„ � i spry,,. 4 Ct ,. ;,,i,, 0 , , , fir"W`,;
/ Clothes washer 25.02
�'C S7A-�C &'r/Gge '' •44-/ `'f / Dishwasher 25.02
-lcQ,.e "�/C .��IC�fr 7,---4 Drinking fountain 25.02
v` 1 Ejectors/sump 25.02
,-. � S Kts ' ,' � r� � #� &� '� � _� Expansion tank 12.51
Name: Fixture/sewer cap 25.02
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
r,„,„,,,,;4;„,„„,,,,., o r d- rir gr Km z; ' r,z, ,Ir -s r i i
priM Interceptor/grease trap 25.02
4 } "e am'a ' R
ar F , aMedical gas(value:$ ) Page 2Business name:/�O4"/1riuPry!,iC e
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory / 25.02 c,25
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
ut25.02
't' T rF ", rc ,, fir ii� &:: s* ,A, kis ,'„1:4:4,,` Water closet
a �� "«, � 7. t� .. v.I.'AANtOt .: `.Z_. 10k't
Water heater 37.52
^�
Business name: v v Uaoist!it 'F Water piping/DWV 56.29
Address: Qac ( g'�3 U r Other: 25.02
City/State/ZIP: , 7%fit �(e. F .�/ (a- Subtotal as:4‘
Phone:($' 3) ( g5-5". Fax:( ) Minimum pennit fee: $72.50 7A.rd
Plan review (25%of permit fee) -----
CCB Lie.: 343 3 5- 5-4311 7 Plumbing Lic.no.:26-.51a2 e,e
State surcharge(12%of permit fee) r 70
Authorized signature: r 1417 TOTAL PERMIT FEE 4f j/l,oie
Print name:
:Zepr!-.._Tve,-.e..._ Date: (��5 (/ 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:Building Permits PLMLI-PermitApp.doc 10 01 09 440-4616T(1002-COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su. I ression S stems:
"- .yam ' F: +�,..
I� ;, ,�0,�»x.�.,� �..=a--,: �..ry'a�.,.,u,...�a s,,�mf€ .ar_„��- ���s��w 1.-7.��w .ter, a->.
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' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 t r �� f; r?�
Stone&Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum fee$72.50
Stone&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
1, t n r. each additional$100.00 or fraction thereof,to
6:77-1-4t "r., � `12'k� u .r� 4k �.;.��.�d ,�� 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-I/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
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*.
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 ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive The, as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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"
4
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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 sewerP ermit 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:A Building\Permits\PLM F_PennitApp.doc 08/04/2011 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10727 SW TITAN LN, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00109
Don Sylvester
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10727 SW TITAN LN, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00109
Don Sylvester
Violation Summary:
Inspector Contractor