Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00076
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/09/2017
T[C ,+1 kt- Parcel: 2S103CB04200
Jurisdiction: Tigard
Site address: 12270 SW MARION ST
Project: Price Subdivision: WILLAMETTE NO.2 Lot: 21
Project Description: Remodel bathroom
Contractor: AGS CONSTRUCTION 1 LLC Owner: PRICE, JOHN H&NORMA J
24606 NW 4TH CT 12270 SW MARION ST
RIDGEFIELD,WA 98642 TIGARD, OR 97223
PHONE: 360-500-0999
PHONE: 503-703-7411
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 03/09/2017 $25.02
Specifics: 2 ea Tub/Shower/Shower Pan 03/09/2017 $25.02
1 ea Water Closet 03/09/2017 $25.02
Type of Use: SF 1 12%State Surcharge- 03/09/2017 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Sp= .ty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is n •rted within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the - adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ..r.in a copy of the rules
or direct qu-. •'s . OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • I Permittee Signature: 1 A
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 H =� � � w -7
-� ' , Received Q /' t'1-1,96/6 4
7 P
City of Tigard Date/B cJ 7 /7 Permit No.:
111 • 13125 SW Hall Blvd.,Tigard,OR7 ?n l/ Plan Review
A Phone: 503.718.2439 Fax: 503.1 960 Date/By: Other Permit No.:
Inspection Line: 503.639.417
I I G A R U 1 a�•t t Date Ready/By: Jude: 0 See Page 2 for
Internet: www.tigard-or.gov t�iilI: },�et�, Notified/Method: Supplemental Information
TYPES `1Vli+ IG LIV S N
FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. Ea. 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-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
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION` Site utilities:
Job site address: 2.2.-702.2.-7031A) Mtt r 1'n�. S' 1. Catch basin or area drain 18.76
,�t, Drywell,leach line,or trench drain 18.76
City/State/ZIP: , \ ft�A V 01722-3
✓ . Footing drain( no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: ,i L „lel 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
`cc,. A Backwater valve 12.51
DES(RIPTJQ� 4"` °' _
�' ' ( Clothes washer 25.02
.a v I^ ^ COt �.�/(414 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
u PROPERTY i1 R. '" , q TENA1V',' Expansion tank 12.51
Name: ? � � 1 r�- Fixture/sewer cap 25.02
Address: ' i 22 70 SU3 Ray y-t o y-A ��t Floor gedroor sink/hub 25.02
n l Garbage disposal 25.02
City/State/ZIP: \ ,i nek r� ' (Q l 67 223 Hose bib 25.02
Phone:( A ) �'� - Fax:( ) Ice maker
12.51
' , 'PLICA1+ '` ' ; a co ' cr PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory / 25.02 0/5:0'7"
City/State/ZIP: $o units(potable water) 62.54
Phone:( ) Fax::( ) ail (showsh wer Pat 12.51 4 5.0 P
E-mail: Urinal 25.02 /
r'° croR Water closet ) 25.02 a5,0�
Water heater 37.52
Business name: n /� j(��� r_ '
tig3 x 1S6cArL'li ..u. L.
L C Water piping/DWV 56.29
Address: 2_46 O U t`1. i-4`14 Other: 25.02
City/State/ZIP: d ..j/' fid •r 611, 4 2_ Subtotal 75.00
P . l Fax:( )I CTi Minimum permit fee: $72.50 \.----Phone:(�O)
Plan review (25%of permit fee)
CCB Lic.: 1149 t' �/ ' umbing Lic.no.: .'ll 12_R
7/ State surcharge(12%of permit fee) ciel
Authorized signature: X I. TOTAL PERMIT FEE 5�,07
Print name: (/�� / (/ /, Date: z 7 This permit application expires if a permit is not obtained within 180 days
" YIP, `'l : •�f►]l( t�tVJ J/0 / after it has been accepted as complete.
/J / *Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(l0/02/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' 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
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*. 'telannReview for Plumbing Installations
Quantity by FixtureType 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 0 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.
CW
C -Commercial
al ❑ Any multipurpose fire sprinkler system.
Dishwasher:
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 k:
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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12270 SW MARION ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2017-00076
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Correction complete, plumbing final approved.
Violation Summary:
Inspector Contractor