Permit (231) CITY OF TIGARD PLUMBING PERMIT
111 ■ COMMUNITY DEVELOPMENT Permit#: PLM2016-00634
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/28/2016
Tri;A R.D9 Parcel: 2S112CB03500
Jurisdiction: Tigard
Site address: 8414 SW ASHFORD ST -
Project: KELLY Subdivision: ASHFORD OAKS NO.2 Lot: 49
Project Description: Interior remodel:(1)clothes washer,(1)garbage disposal,(1)hose bib,(1)ice maker,(2)sinks,(1)tub,and(1)
water closet.
Contractor: MARK WHITED PLUMBING Owner: KELLY,JANICE J
10625 NW LOST PARK DR 8414 SW ASHFORD ST
PORTLAND, OR 97229 TIGARD, OR 97224
PHONE: 503-351-5985 PHONE:
FAX: 503-626-9693
FEES
Quantity Description Date Amount
1 ea Clothes Washer 12/28/2016 $25.02
Specifics: 1 ea Garbage Disposal 12/28/2016 $25.02
1 ea Hose Bib 12/28/2016 $25.02
Type of Use: SF 1 ea Ice Maker 12/28/2016 $12.51
Class of Work: ALT 2 ea Sink 12/28/2016 $50.04
Type of Const: 1 ea Tub/Shower/Shower Pan 12/28/2016 $12.51
Occupancy Grp: 1 ea Water Closet 12/28/2016 $25.02
Stories: 1 12%State Surcharge- 12/28/2016 $21.02
Plumbing
Total $196.16
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:
ELAA--erc:—
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 Fixtures FOR OFFICE USE ONLI
City of Tigard Received .�r�
g Y , _2 /6 �-�-- Permit No.: j
Date/By: �[✓M I �j�14?,
Ili 13125 SW Hall Blvd.,Tigard,OR 97223, ��
_ Plan Review
Phone: 503.718.2439 Fax: 503. �fl6 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 11a�"
T I G A P.D „ r O'� Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov ` ( Notified/Method: �. Supplemental Information
-
' TYPE OF WORK �� itaAS{D FEE* SCHEDULE
0 New construction ❑O%�lil] `gl�jttFor special information use checklist
.9u ("1kti�� Description Qty. Ea. I Total
yeAddition/alteration/replacement h uhiet`•' New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
01-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
o Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: tf-I± Ad j s'•.� Catch basin or area drain 18.76
Ci /State/ZIP: �V�`��tfT���✓✓✓ Drywell,leach line,or trench drain 18.76
ty /T�f �' el Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: ,,``
I°lG/A 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 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
DESCRIPTION OF.WORK '''It''''
�
Backwater valve 12.51
.
' `" Clothes washer .t 25.02 ; "
Dishwasher 25.02
i..�� TIN, L(( IA (,,, ---- /J c. 7I--‹see,L ‹/4 Drinking fountain 25.02
Ctt. s jwe L4e v- 1,...„... i., ..... Ejectors/sump 25.02
Expansion tank 12.51
1:3PROPERTY U4!1R TENANT P
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal f 25.02 �':
City/State/ZIP: �".
Hose bib < 25.02 ,25-14,�-'�
Phone:( ) Fax:( ) Ice maker NTT12.51 11.
0 APPLICANT El CONTACT PERSON Interceptor/grease trap h 25.02
Business name:i\,(r,_ �- W �� �` Medical gas(value:$ ) Page 2
Contact name: ___l"`C"'LLL""a..,,' 4- `��KCCx2!!f_,....-- �yc�-p 1 Primer 12.51
L_�` '/ `'`�L.2!
" Roof drain(commercial) 12.51
Address: V t.„..0 j( ( Sink/basin/lavatory 25.025-0,04
City/State/ZIP: { «� ""
� /C1�A .-22,_.a 5 Solar units(potable water) of 62.54
v 11 j Tub/shower/shower
Phone:�l) 3� � " C,y c Fax::S� `�� ���� pan 12.51 101 y
E-mail a.(.t�. f�CtL-tc4C- --Zl e ee e��c (../-4_4--- Urinal 25.02
• Water closet !I25.02 )..5", ,,
CONTRACTOR
Water heater 37.52
Business name: WAter piping/DW V 56.29
Address: � 7 Other: 25.02
City/State/ZIP: � Subtotal / 7.5.--IK
Phone:( ) Fax:( ) Minimum permit fee: $72.50 -.
CCB Lic.:3f)S`7 Plumbin Lic.no.: .•._/V Plan review (25%of permit fee) -
I State surcharge(12%of permit fee) ) I,L'k`
Authorized signature: V LA.)` TOTAL PERMIT FEE Tl IL.,It;
Print name: Q-IP t ( 05. Date:/ 41., This permit application expires if a permit is not obtained wit/in 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PernutApp.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:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1 s`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 Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Feesand 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 Plumbing Installations,
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
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
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"
3" Isometric or Riser Diagram
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
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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2