Permit (191) CITY OF TIGARDt ii .IN PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018 00104
T t cG 1 fkD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2018
fir, . Parcel: 2S110DD10600
IMAra
Jurisdiction: Tigard
Site address: 10940 SW HIGHLAND DR
Project: Haywood Subdivision: SUMMERFIELD NO.6
Project Description: Replacing water piping throughout entire house.3/19/18:REPRINTED permit to include(1)clothes washer,(1) Lot: 322
dishwasher,(1)garbage disposal,(1)ice maker,(4)sinks,(3)tub/shower,(2)water closets,and(1)water heater.
Contractor: PEACE OF MIND LLC Owner: HAYWOOD, CHARLES W 1991 REVOCABLE TRL
PO BOX 1674 WIEST-HAYWOOD, G 1999 REVOCABLE
OREGON CITY, OR 97045 TRUST
10940 SW HIGHLAND DR
TIGARD, OR 97224
PHONE: 503-344-4705 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 03/19/2018 $25.02
Specifics: 1 ea Dishwasher 03/19/2018 $25.02
1 ea Garbage Disposal 03/19/2018 $25.02
Type of Use: SF
Class of Work: ALT 1 ea Ice Maker 03/19/2018 $12.51
Type of Const: 4 ea Sink 03/19/2018 $100.08
3 ea Tub/Shower/Shower Pan 03/19/2018 $37.53
Occupancy Grp: 1 ea Water Piping/DWV 03/15/2018
Stories: $56.29
2 ea Water Closet 03/19/2018 $50.04
1 ea Water Heater 03/19/2018 $37.52
1 12%State Surcharge- 03/19/2018 $44.28
Plumbing
Total $413.31
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 503.232.1987332:2344,\
Issued By:
_4f d �?:-- t----
Call 503.639.4175 by 7:00 a.m.for the next available inspecti ate.
This permit card shall be kept in a conspicuous place on the job site until c., pletion of the project.
Approved plans are required on the job site at the time of each inspection.
dumbing Permit An 11 .1L13ECEIVED
Building Fixtures FOR orr]CI: LSI. ()NIA
City of Tigard MAR 15 2018 Received
DateBy: 3 /S//if , Permit No.:/04,4:4249/g.--610i d
13125 SW Hall Blvd.,Tigard,OR 972
' Phone: 503.718.2439 Fax: 503.598. LTY OF FIGARD Plan Review 0
1 ^ ate/By: Other Permit No �-1��
1 IC A IZ D Inspection Line: 503.639.4175 BUILDING DMS II?' bate Ready/By: suis; ® Page f r 7_doy�
Internet www.tigard-or.gov Notified/Method: Supplemental Information
t C i �.'. 5 i t7 C p v/Ir 4''''':.'w::
ik' 4, ' k i.M f 5
It C.., r ..t .4 .' a:i4S,6e. �g .j 1. ':'4' ':114:144471• ' Y �.„T 3"y`-t 4z ,'h. ,e,�,, e; �
.44,}.y.:v.�, raa`.,�'xa 4,,-« :;" ' s , t..6. , m, s Ij 4t ,r:ti` 1 tel,,s"M'a a iMiAt`,. ,: .x,,',1s,...,-..,, d '� ,a t
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
:#14 6,414 `1t -sr;;oi, ',r:4 �" . 'lir+ - +, ,. y = SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercia a,,', i i t t SFR(2)bath 437.78
ztio ,� , SFR(3)bath 500.32
❑Accessory building 0 Multi-famil l
7 V' `
us -°1 Each additional bath/kitchen
❑Master builder 0 Other: 25.02
Fire sprinkler( sq.ft.) Page 2
a.,, x 45, ..k ,, „ '4:.,.` wM. � , g , Site utilities:
Job site address:10940 SW Highland Dr Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:
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
yaw r_; k -r;1)•��,, I sti A� 1ke a Backwater valve 12.51
..� �, , � ,r4) _ rir.b_. ..*Ar . , ...,:k.:,,.,,,,,-.r:',,,%:,4,..',,-4.,...,--, ,4,-,
_ Clothes washer )
Re-plumbing 2 bathrooms,kitchen,and laundry room ��ole ,..„404 /i���iy 25.02 .Z Su di
3/ / C Cbuse- DishwasherAbi 31��i`1•' ' 25.02 �J ,,...
/ : `e(#G� U)ei, J 4ryJ 0C�y �Lt.rl 6).4 y�.� drinking fountain 1 25.02
4,4
(.4 (j ,, fi1 (4,,„,,,,,,...„1,1, 1 Ejectors/sump 25.02
„„.4 . ,A+ +sa Re
-�je Y� Ssff � #)�. as.,r `k k +4s wg�' r_-
4-.a, .4 s 7:'iV , i: zi p t ., TIM .t,> 1 a/1,PPansien tank 12.51
Name:Gail Haywood Fixture/sewer cap 25.02
Address:10940 SW Highland Dr fi�lFloor drain floor sink/hub 25.02
- Garbage disposal ( 3jstiJi 1 25.02 1>'G j.
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:(408)420-4776 Fax ( ) Ice maker 1 '.S i's- ..i
#tea F aw uit t .L.3/i 1 ► 1 12.51
1, .zs- � was 0 -;0 ,r,.,._ �;-.4..''' ''Y':•.;. . . .,,';. ,. Interceptor/grease trap 25.02
Business name:J-Chavez Design Build Medical gas(value:$ ) Page 2
Contact name:Jacob Chavez Primer 12.51
Roof drain(commercial) 12.51
Address:1327 SE Tacoma St#180
Sink/basin/lavatory 4,3/j4r i.4 25.02 /W. '
City/State/ZIP:Portland,OR 97202 Solar units(potable water) 62.54
Phone:(503)833-2433 Fax::( ) Tub/shower/shower a` 45/t4 3 12.51 3 7 53_
E-mail:jchavezdesign@gmail.com Urinal �1^'"`l 25.02
ti fA 'r , Water closet #4
1
r '2. 25.02 5-C? ill
"' '. Water heater Arleta3/014 I 37.52
Business name:Peace of Mind LLC Water piping/DWV 56.29 s�
Address:PO Box 1674 Other: 25.02
City/State/ZIP:Oregon City,OR 97045 Subtotal
Phone:(503)936-6968 Fax:( ) Minimum permit fee: $72.50
CCB Lie.:215878 Plumbing Lic.no.:PB1905 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: ,MtI/1 A111/?147116 `
TOTAL PERMIT FE 3 3 I J
Print name:Delton Dominique Date:03/15/2018 This permit application expires if a permit is not obtained within 180 days
• 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)
111 I CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00104
T i C.A IZ L) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2018
Parcel: 2S110DD10600
Jurisdiction: Tigard
Site address: 10940 SW HIGHLAND DR
Project: Haywood Subdivision: SUMMERFIELD NO.6
Project Description: Replacing water piping throughout entire house. Lot: 322
Contractor: PEACE OF MIND LLCOwner: HAYWOOD, CHARLES W 1991 REVOCABLE TRL
PO BOX 1674 WIEST-HAYWOOD, G 1999 REVOCABLE
OREGON CITY, OR 97045 TRUST
10940 SW HIGHLAND DR
TIGARD, OR 97224
PHONE: 503-344-4705 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 03/15/2018 $56.29
Specifics: 1 12%State Surcharge- 03/15/2018
Plumbing $8.70
Type of Use: SF 16 ea Minimum Fee Adjustment- 03/15/2018 $16.21
Class of Work: ALT Plumbing
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 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:Aopd. .41., Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspecti 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.
'w
7 Plumbing Permit Ap licatio C; 1,
Building Fixtures
City of Tigard MAR 1 h 2018 Received
Illi 13125 SW Hall Blvd.,Tigard,OR 972 lT5j `ro �q Date/By: 3 /S�/�/e�, Permit No.: 2 1!JF 661 n`S
!IN
li Phone: 503.718.2439 Fax: 503.598.440 1 V ` ll5rlL. Plan Review /`vll� Q�LJ V [
Date/By: Other Permit No
TIGARD
Inspection Line: 503.639.4175 BUILDING' l .I'loN e �Ailge2for -�70`7�3
Internet: www.tigard-or.gov Date Ready By: 7u is: ® See Page 2 for
oh led/Method
Supplemental Inform anon
lklibll , EOff' '4 pcgennigla ED
❑New construction ❑Demolition For special information use checklist
- Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other:
New 1-2-family dwellings(includes 100 ft.for each utility connection)_
.i�,,, s... .. e.,; ,CA` dt* C'ON TR3„C' SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
r) B I RMAT,IO D L A' O Site utilities:
Job site address:10940 SW Highland Dr Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:
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
diktpletigetnfilyet T+ WORD Backwater valve 12.51
Re-plumbing 2 bathrooms,kitchen,and laundry room J tr1 ire 1,1„,,,, Clothes washer 25.02
>e,
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump
.. . ►a PROP TY 11 TE N� T Expansion tank 12.51
25 02
Name:Gail Haywood Fixture/sewer cap 25.02
Address:10940 SW Highland Dr Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224
Hose bib 25.02
Phone:(408)420-4776 Fax ( ) Ice maker
12.51
,u>a t �, 0 #hl �T PERSON Interceptor/grease trap 25.02
Business name:J-Chavez Design Build Medical gas(value:$ ) Page 2
Contact name:Jacob Chavez Primer 12.51
Address:1327 SE Tacoma St#180 Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:Portland,OR 97202 Solar units(potable water) 62.54
Phone:(503)833-2433 Fax::( ) Tub/shower/shower pan 12.51
E-mail:jchavezdesign@gmail.com Urinal 25.02
��. Water closet 25.02
v Water heater
Business name:Peace of Mind LLC 37.52
Water piping/DWV I' 56.29
Address:PO Box 1674
Other: 25.02
City/State/ZIP:Oregon City,OR 97045 Subtotal
Phone:(503)936-6968 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:215878 Plumbing Lic.no.:PB1905 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: ZLtDf10' 9/wi9Gle
TOTAL PERMIT FEE
Print name:Delton Dominique Date:03/15/2018 This permit application expires if a permit is not obtained within 180 days
after 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)
0 Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
... A ". '
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
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
Sewer-each additional 100' 7,201 and greater $327.54
37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' 37.52 Medical Gas Systems:
r z
Storm&Rain Drain-1st 100' 62.54 ifititt " .Yd "- �>� rte
Storm&Ram Drain each additional 100 37 $1.00 to$5,000.00 Minimum fee$72.50
�, $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
�ti7 � 4n .' )v` *° 52 tl t fort each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for
and including$10,000.00.
$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
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including$25,000.00.
hours(minimum charge-2 hours) $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
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*.
9uadtlty by Fixture Type
e T}pe r TLeptaeel itlilrnevielv4or 1 m
Work P-erf+Oriuet Gapped`; Added kel(u atc:; Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ My 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 ❑ 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.
-3"
•
Car Wash Drain •N 4,
� "� r>
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
Washer-clothes *Note: If the fixture work under this permit results in an
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:
E:\Dropbox\Jacobs_Projects\Gail Haywood Remodel\Permitting\PLMF_P2rmitApp(1).doc