Permit (52) 'PiCITY OF TIGARD PLUMBING PERMIT
R COMMUNITY DEVELOPMENT Permit#: PLM2017-00347
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/29/2017
Parcel: 2S110DD90112
Jurisdiction: Tigard
Site address: 10960 SW MEADOWBROOK DR 11
Project: WOLFE Subdivision:SUMMERFIELD BROOKSIDE CONDO Lot: 11
Project Description: Shower and tub replacement.
Contractor: CENTRAL OREGON PLUMBING SERVICE LLC Owner: WOLFE, VICTOR D
PO BOX 696 10960 SW MEADOWBROOK DR#11
NEWBERG, OR 97132 TIGARD, OR 97224
PHONE: 541-390-4797 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 08/29/2017 $12.51
Specifics: 1 12%State Surcharge- 08/29/2017 $8.70
Plumbing
Type of Use: MF 60 ea Minimum Fee Adjustment- 08/29/2017 $59.99
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 95 -001-0090. You may ob,:in a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ittee Signature: ,
lbh.
10
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 0,r FOR OFF IL . 1 SF. ONLI
City of Tigard .,V�: - Iv . 4 ` Received /
Date/By: /� 1 Permit No �/ //i d�/I i �
•
NI 13125 SW Hall Blvd.,Tigard,OR 97223
r, Plan Review
Phone: 503.718.2439 Fax: 503.598.1960�j U 9 2017 Date/By: Other Permit No.:
Inspection Line: 503 639.4175 2 Date Rea /B Juris H See Page 2 for
r it.,ARD Ready/By: B
Internet: www.tigard-or.gov i° Notified/Method: Supplemental Information
Jf i1t4 t
TYFt OF'W ImoD* SCID0
❑New construction i effi81ion �I For special information use checklis!
Description Qty. Ea. Total
[✓Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
+t: T GC A, €}F� N SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
SGA SITE-IN(4+'ORMATION AND ATJO Site utilities:
I
Job site address: I 0 � \ 2L- C(Lr Catch basin or area drain 18.76
Cg„City/State/ZIP: ��,.y�V''��t�� '7 c Drywell,leach line,or trench drain 18.76
.. i �- Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1, l } Project name: ( co: \ Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
v'V1 v'V 1 C12-Pt al) 0 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
II $CRI QN ally l `.,
Backwater valve 12.51
Clothes washer 25.02
4,t `-'" i tom'(,, t/ °'`"'E-2 17-,03 Dishwasher 25.02
Vitt1 --- Drinking fountain 25.02
Ejectors/sump 25.02
It n 0, b.'TENANT Expansion tank 12.51
. .._..__ � .. .. . ....a a-, _� �. e.�..,
F Vzj 7 \iFixture/sewer cap 25.02
Name: � (,,,,�1C._
_ Floor drain/floor sink/hub 25.02
Address:
�y� � \ft) V=� � Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
►puc, T "' Ci coNua ttusoiiInterceptor/grease trap 25.02
Business name:
‹1_,„\2\ Medical gas(value:$ ) Page 2
`��,��1��, ��, y t
Contact nam . Primer 12.51
J N7-)
" iA J Roof drain(commercial) 12.51
Address:
<�r�� 6�3 i 73- Sink/basin/lavatory 25.02
City/State/ZIP: /U 6- ( Er G. ( ct I -- z__ Solar units(potable water) 62.54
Phone: 7)I 2- ' Fax::( ) Tub/shower/shower pan / 12.51 ii),.5-I
E-mail: Sqci,kq icriUrinal 25.02
�, ., Watescloset 25.02
CU1�TIi�k�iR'
Water heater 37.52
Business name: ( E LLt (''\ N (\ Water piping/DWV 56.29
Address: ?IP° 6r)�( ( c9ip Other: 25.02
City/State/ZIP: �� T 1 C. t�'� Subtotal /)�,��
Phone:(5.it ) . 10 _ ;-I Fax:( ) "74 frii , Minimum permit fee: $72.50 '-70)._522 Plan review (25%of permit fee)
CCB Lie.: ?/yi •--e Plumbing Lic.no.: State surcharge(12%of permit fee) 1
co Authorized signature: �` �,,�r., h5i..„.... i w3 TOTAL PERMIT FEE �-j.).y,3
~
Print name: J6 I8
This permit application expires if a permit is not obtained within 0 days
- t� ( �+�1{ Date: 1after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\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:
Footing drain-i'`100' 50.03 0 to 2,000 $121.90
Footing dram-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
$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
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*.
Quauti y by i 1 Ce f3'tr+
FixtureTypefor ,n "' Plan review is required for any of the following.
Work Perfor ed. Capped: Added' ***mot
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
•
4 Itrl
Car Wash Drain
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\SQUARE-1\AppData\Local\Temp\PLMF PermitApp.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10960 SW MEADOWBROOK DR 11 , TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2017-00347
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Correction is complete, plumbing final - approved
Violation Summary:
Inspector Contractor