Permit (31) CITY OF TIGARD PLUMBING PERMIT
�f COMMUNITY DEVELOPMENT Permit#: PLM2017-00270
Ti AFt D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2017
Parcel: 2S104CD00201
Jurisdiction: Tigard
Site address: 13553 SW HILLSHIRE DR
Project: Burnett Subdivision: HILLSHIRE ESTATES Lot: 2
Project Description: Moving drain and vent for(1)sink,and moving supply for(1)ice maker; Installing(1)garbage disposal and(1)pot
filler.
Contractor: STANDARD PLUMBING&HEATING Owner: BURNETT,WAYNE A&ELIANE
8318 SW SPRUCE 13553 SW HILLSHIRE DR
PORTLAND, OR 97223 TIGARD, OR 97223
PHONE: 503-246-3338 PHONE: 208-841-7562
FAX:
FEES
Quantity Description Date Amount
1 ea Garbage Disposal 07/10/2017 $25.02
Specifics: 1 ea Ice Maker 07/10/2017 $12.51
1 ea Sink 07/10/2017 $25.02
Type of Use: SF 25 Misc Other Fee 07/10/2017 $25.02
Class of Work: ALT 1 12%State Surcharge- 07/10/2017 $10.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $98.08
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 o ollow the rules .dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-I t -01'."0 You may'.'ain "copy of the rules
or direct questions to OUNC by calling 503.232.1987 . ;I I 2.2344.
e"--- 7
Issued By: /- Permittee Signature: -_ Ar�a1. ) j
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 ONLY
City of Tigard Received -, �
- Date/By: ! jd/' Permit No.:�Qf„_ r�aI 7_�x7i 7)
13125 SW Hall Blvd.,Tigard,OR 97223 z ,124
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
r., Date/By: Other Permit No.: o
Inspection Line: 503.639.4175 � Jf 7
T 1 C ARD Date Ready/By: Juris: See Page 2 for
Internet: www.tigard-or.gov Date Read /By: Supplemental Information
TYPE OF WORD Q ?��1 FEE* SCHEDULE
0 New construction 0 DemoltIt 1 t For special information use checklist
Lz Addition/alteration/replacement ❑Ot , 4'�- 16 1 ; Description Qty. Ea. Total
�' j ,O,�+ g�t� � New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRyist 1 SA 6� SFR(1)bath 312.70
l 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 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: t( 3 5-s-3 S ( -z CLS strati: De
Catch basin or area drain 18.76
City/State/ZIP: TIGA-7.4-4 0 (� 9 7 �� Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 4U.2Nfi T'l` 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 W f , J his ; Backwater valve 12.51"�0 _ Clothes washer
/�'0 Vii /I�A1► � VI2 Al'T /-a2 S N i`L Dishwasher 25.02
114(10)4_ S cJ 4/l t y` rag_ `7-ca ,.-4- 'z+�.'Z. 25.02
Drinking fountain 25.02
40,....e.-40,....e.- Ido N IZ...J $ it/tOt y Ejectors/sump 25.02
I'O PE S WNER 4t fi .., ft T NANT Expansion tank 12.51
Name: f�l�:.!t� 6 J/L,�/ErrFixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: / 1.;"<"3 S„d fi-x C S f ',2.iii: 04-
City/State/ZIP: 'r`�� o UiL q 7 3 Garbagedisposal 25.02 1A.5";0
`l Hoseebib 25.02
Phone:(10 8) e/0 7 c(a 2. Fax ( ) Ice maker
t 12.51 12S-1
t; ,y APPLICANT,x CONTACT=, , .`4 rN Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
,...5
S4.1j
"j Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory
I 25.02 ,5.41
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: V
(',� � I• x • :WaterPiP�F�WV 56.29
Address:
1 V V e GQ� otherO - c.. 1 25.02 01.5`,y
City/State/ZIP: VI!) p i (0 0 1 Z,2_,2,,,....S _ (g t- F,%fr(- ) Subtotal
Phone:(SO3) 7 L,(n ..y725 V Fax:( ) -jr 11 Minimum permit fee: $72.50 �.5�,
CCB Lic.: ', p-fr _ Plu. Bing Lic.no. , , �, Qt Plan review (25%of permit fee)
` i'l State surcharge(12%of permit fee) ,t3.
Authorized signature: 5�
/ lly l
/ t I TOTAL PERMIT FEE
Print name: e t 151. 6,k, \ Date: 1 , r l This permit application expires if a permit is not obtained within days
fit/` I after it has been accepted as complete.
666 *Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pamits\PLMU-PermitApp.doe 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 UtilitiesQtY Fee(ea) Total Square Footage: Permit Fee:
Footing drain-la 100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 Fees 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
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*. <<x . . Plan Re ie v. for Pl umbiitg Ins -41100,0 $ .5
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 ❑ 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3>, 'SomBt$'wi0 ',Rise3 g
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
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