Permit (70) CITY OF TIGARD PLUMBING PERMIT
F2. ` COMMUNITY DEVELOPMENTIN
Permit#: PLM2016 00526
Date Issued: 10/18/2016
-i [G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110BB02400
Jurisdiction: Tigard
Site address: 12180 SW CHANDLER DR
Project: CARNESE Subdivision: ARLINGTON RIDGE Lot: 1
Project Description: Replacing(4)sinks and(1)tub.
Contractor: GREEN REPIPE LLC Owner: CARNESE, GREG S&JACQUELINE L
6022 NE 15TH AVE 3310 CEDAR CT
PORTLAND, OR 97211 LAKE OSWEGO, OR 97034
PHONE: 503-501-1469 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 ea Sink 10/18/2016 $100.08
Specifics: 1 ea Tub/Shower/Shower Pan 10/18/2016 $12:51
1 12%State Surcharge- 10/18/2016 $13.51
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $126.10
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 ' :-- ' 111-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.81v. - 44.
Issued By:/�/ %Permittee Signature: -
—�� �_�• 1/1. 2_
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Call 50 .639.4175 by 7:00 a.m.for the next available inspon 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 Ap licatio , 1
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Building Fixtures FOR OFFICE use Ones
Cl of Tigard (( 1 01 1 Receivedil Permit No.: y cr �,'.•
13125 SW Hall Blvd.,Tigard,OR 97223 l (- Date/By: �� i f 16' i„ o i 6 .,0,5 r
g Plan Review
II Phone: 503.718.2439 Fax: 503.598.1960 ~^��,�;1 t' y Date/By. Other Permit No.:
T t G A R D Inspection Line: 503.639.4175 �IiJ 1 1 t�( (� to Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov 1J A �+� tified Method: /c Supplemental Information
t TYPE OF WO k
,,� FEE*'SCHEDULE"
❑New construction 0 Demolition For special information use checklist
Description I Qty. Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION " SFR(1)bath 312.70
❑ 1-apd 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
JOB SITE INFORMATION AND LOCATIONt Site utilities:
Job site address: t . I '10 s, to ., Ch ti - . toy 'P O , Catch basin or area drain 18.76
�/�/� '')7
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -�, rA 0 r 1 (-0(L ( 7 2---2--Li Footing drain(no.linear ft.:_) Page 2
J o
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
C_e___ �--r� . L fI z` Rain drain connector 18.76
��, t
ck A `/I i\4 n 1 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
Backwater valve 12.51
DESCRIPTION OF;WORK rc'
- ' Clothes washer 25.02
E-A.4-_--c- , ��V Y �'e {2'( ' 5 k,Y\z 5 Dishwasher 25.02
,-- C) Yo Drinking fountain 25.02
Ejectors/sump 25.02
ROPERTT OWNER L ry= _I TENANT . Expansion tank 12.51
Cal( IA.( p j r n Fixture/sewer cap 25.02
Name: .ec C.W` ► 'T -" J Q Lam! GLJ�
/� ( , Floor drain/floor sink/hub 25.02
Address: ] ( Ct � r ( i9 r Garbage disposal 25.02
City/State/ZIP:7R `Q l.2 eO\O l�.-f-- 47C 1 Hose bib 25.02
Phone:( U3 CO k y 3s ax:( ) Ice maker 12.51
.0:APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
�I
Primer 12.51
Medical gas(value:$ ) Page 2
Business name:
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 9 25.02 *k);03
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan / 12.51 /A A.`J I
Urinal 25.02
E-mail:
.- Water closet 25.02
CONTRACTOR. ,.
i- Water heater 37.52
�s �Business name: Rep� LX_,_ Water piping/DWV 56.29
Address: 619� )=-►&111.-7t"t.. Other: 25.02
City/State/ZIP: - a-v tie q 7a10/ Subtotal /( 57
b / _ Minimum permit fee: $72.50 ..----�
Phone:(5 ) 0�" ._/� Fax:( ) ify 0 _
�4 (1f to f/5_'t t1 rife ���1� Plan review (25%a of permit fee)
CCB Lic.: �' PlumbingLic.no.: f/
State surcharge(12/o of permit fee)
Authorized signatur-411/ ? y , C��A TOTAL PERMIT FEE ( , la
�q ! c
r��j+ ^� 9 ie !; C i,' �• '! Date: OAS/ /� This permit application expireshif a permit is not obtained within AO days
Print name: fi '/i ,C ,uL C/, M after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB)
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 y 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 Insp Inspections or Fees '. Feelea) 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 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*. Plan Review for Numbing bastallationtl.
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
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall
0 New exterior plumbing site utilities for any complex structure
tall as defined in OAR918-780-0040.
-DrivCuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 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"
F.:isometric or Riser Diagram
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 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:
I:\Building\Permits\PLMF_PermitApp.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
12180 SW CHANDLER DR, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
November 9, 2016 at 12:55:37
PM
PLM2016-00526
Don Sylvester
1. Correction complete - plumbing final approved
Violation Summary:
Inspector Contractor