Permit (117) CITY OF TIGARD PLUMBING PERMIT
S. ' COMMUNITY DEVELOPMENT11111
Permit#: PLM2017 00504
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/11/2017
i A fd-i Parcel: 2S102AB02402
Jurisdiction: Tigard
Site address: 12501 SW MAIN ST
Project: Spec Space Subdivision:ELECTRIC ADDITION TO TIGARDVILLE Lot: 15
Project Description: Interior plumbing for TI:Capping(1)water closet;Adding(5)tub/showers and(1)clothes washer;Relocating(1)
water closet.
Contractor: WEST LINN PLUMBING Owner: VIZUMA LLC
16470 SW BROOKMAN RD 5611 NE COLUMBIA BLVD
SHERWOOD, OR 97140 PORTLAND, OR 97218
PHONE: 503-740-8251 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 12/06/2017 $25.02
Specifics: 1 ea Fixture/Sewer Cap 12/06/2017 $25.02
1 ea Sink 12/06/2017 $25.02
Type of Use: COM 5 ea Tub/Shower/Shower Pan 12/06/2017 $62.55
Class of Work: ALT 1 ea Water Closet 12/06/2017 $25.02
Type of Const: 1 ea Water Heater 12/06/2017 $37.52
Occupancy Grp: 1 12%State Surcharge- 12/06/2017 $24.02
Stories: Plumbing
Total $224.17
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 requiresou to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952 11-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. . II i
I'
Issued By: •i i� Permittee ignature: i
/44
Call 503.639.4175 by 7:00 a.m.for the next available insption date.
This permit card shall be kept in a conspicuous place on the job site unti <ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures ,v::‘8,N till FOR OFFICE USF ONE
City of Tigard Received
Permit No.:
ig 13125 SW Hall Blvd.,Tigard,OR 9722 Date/By: I�?-1`;l 7 �` c1It/
C Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 r� Date/By: Other Permit No.:
Inspection Line: 503.639.4175 (� � I �
T 1 l;A R D 13 C to Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov v `� tified/Method: j Supplemental Information
TYPE O.F.-WORK 'vtO't \ �
�..t.. ktttnic0.� ��� y' FE.* SCHEDULE =
��I For special information use checklist
ID New construction 0 Demoi
Description I Qty. Ea. I Total
i231 Addition/alteration/replacement 0 Oth . 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 '1 Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
o Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INl1ORMATION AND LOCATION Site utilities:
\-2 _53 ` � I Catch basin or area drain 18.76
Job site address:
1 vV \fAl t� � Drywell,leach line,or trench drain 18.76
City/State/ZIP: 'l C\G`C�C'Ji Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: 5prez � 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
Stone 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
VI .;� DESC'It1�'JO�,OF WORK � ti.
Backwater valve 12.51
_ "`' Clothes washer / 25.02 ✓5- !1.
�J C Vva j�\l t ��f-.C., `n- VjCl`4 A L .�1Dishwasher 25.02
W ! . , C tc� vv,`-, kiU��Yie C Drinking fountain 25.02
Ejectors/sump 25.02
I
$PROPERTY fiOWNER ❑ wx. b' . Expansion tank 12.51
Name: Fixture/sewer cap I 25.02 9.j 0 J'`
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
• CI APPLIC 4 V i; _❑.CONTACT"l [tSON a Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 1 25.02 y2 .U,k
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 5 12.51 L a.5-3-.
E-mail: Urinal 25.02
z ff
Water closet I 25.02
1,- CONTRACTOR ;. t a
- ..,. _ .. - Water heater i 37.52 -3'].5 J..
Business name: \�L 5� L.;,,,-\ �'V�r����� Water piping/DW V 56.29
Address: k 4)Lk-A( '-) i 1'����C moan V.cA Other: 25.02
City/State/ZIP: ` 7{mac i ,�(x,C\ ( ) Ck )`'-f. Subtotal 15"'
Phone:(i j ) (._ Cy. I?.5 I Fax:( ) Minimum permit fee: $72.50
CCB Lic.: \%G.L.\ _\ )Plumbing Lic.no.: ��,CJ 1�C1`1 Plan review (25%of permit fee)
State surcharge(12%of permit fee) )-u,0
Authorized signature: Let 0 el �'/ j( t l// TOTAL PERMIT FEE . 1, 7
\-)c,1/4v
��� This permit application expires if a permit is not obtained within 180 days
Print name:
1v���. lc,/ , 3'' Date: ( _ _.. `� 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(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities M1 t'• Fee(ea ` Total .Square Permit
14
:� P.
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
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
Other Inspections or Fees Qty. ee(ea) 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*. .'lan. view for Plumbing Installati
Quantity by Fixtute 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
engine
-Jacuzzi/Whirlpool
Car Wash: -Each Stall El New exxr.
terior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
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"
m Isome ir.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 1 plumbing permit can be issued.
Urinal
Other Fixtures:
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