Permit (200) CITY OF TIGARD PLUMBING PERMIT
AY
COMMUNITY DEVELOPMENT Permit#: PLM2019-00213
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/20/2019
Parcel: 2S112BA90381
Jurisdiction:
Site address: 7955 SW FANNO CREEK DR 4
Project: BLOMQUIST Subdivision:)NITA FIRS VILLAGE CONDO(PHASE Lot: 38
Project Description: Repairing 40 ft.of sanitary sewer.
Contractor: GATES PLUMBING & REMODELING LLC Owner: BLOMQUIST, NORMA A LIVING TRUST
8838 SE STARK ST 7955 SW FANNO CREEK DR#4
PORTLAND, OR 97216 TIGARD, OR 97224
PHONE: 360-904-8067 PHONE:
FAX:
FEES
Quantity Description Date Amount
40 If Sanitary Sewer 05/20/2019 $62.54
Specifics: 1 12%State Surcharge- 05/20/2019 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 05/20/2019 $9.96
Type of Use: SF 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 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 1 $110.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
- - _ .• .• _ • .. '. . •. 0. . - . . - •, .: '•• n ' •m•letion of the •ro'ect.
Approved plans are required on the job site at the time of each inspection.
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LUMBING PERMIT APPLICATION /3
-,*2.4:4-'1'''' '"----, City of Portland, Oregon - Bureau of Development Services
1900 SW 4th Avenue,Portland,Oregon 97201•503-823-7300•TTY 503-823-6868•www.portlandoregon.gov/bds
Type of work This permit application expires if a permit is not
❑New construction ! ddition/alteration/replan m' - obtained within 180 days after it has been accepted
as complete.
❑Demolition I Other: . i i Q19
Fee Schedule
Category of construction
_ Description Qty. Fee Total
1 &2 family dwelling ❑Commercial/industrial ❑Accl y. ITi. r flew 1&2 family dwellings
!N a D%Vi' includes 100 ft.for each utilit connection
Multifamily ❑Master builder ❑0 ��� SFR(1)bath $520
Job site information and location SFR(2)bath $780
Job no.: Job address: 11 q l) 5.43. cry 0 n t��„;) CSFT(3)bath $910
�/Y LW 1�Jf- Each additional bath/kitchen $218
City/State/ZIP: Mkt�61 bQ O1 134 /� Fire sprinkler( sq.ft.) Per fee schedule
Suite/bldg./apt.no.: .(x'11 I Project namecit
. ►� ^i' /- /
{ �-�/ (A ' Catch basin or area drain $39
Cross street/directions to job site: Manufactured home utilities $92
The following fees for exterior lines are in addition to unit fixture
Subdivision: Lot no. Tax map/parcel no. fees.The prices listed below are for the first 100 feet.Each
Description of work(example:2 fixtures for kitchen remodel) additional 1oo feet orportion thereof is._$s ...................................
I
Rain drain( linear ft.) $116
SC- A.,\n c�
Ai_�eA Ctp(yAir. Installing drywell? ❑yes ❑ no No fee
T
Sanitary sewer(kip r linear ft.) $116
Storm sewer( linear ft.) $116
....................................................................................................................
Provide RS Permit no. Water service( linear ft.) $116
• Property owner • Tenant Fixture or item
Backflow preventer $39
Name: /....4, /t J -,iA/3- / E-mail: Backwater valve $39
N ,.s �s• t, y / � Clothes washer $39
Address: (,� ,J ((WUU ly- Dishwasher $39
City/State/ZIP: •f r-�lC lllr 0 P___. Qj 7 d-a„„l.f Drinking fountain $39
Phone: I FAX: Ejectors/sump $39
Fixture cap $39
Owner installation:This installation is being made on property that I own,which is not intended for sale,lease,rent, Floor drain/floor sink/primer $39
or exchange. Garbage disposal $39
Owner signature: Date: Hose bib $39
FA Contractor • Subcontractor Ice maker $39
Interceptor/grease trap $39
Business name: ( E-mail:
17i � ` ��� Interior mainline piping
Address: 8. 35 G / t_Sr Water piping-first 100 feet $116........................................
�
,, ^lYt
Drainage piping-first 100 feet $116
City/State/ZIP:
1�v 4 `U0.' �Q r`— 61-744(a) Each additional 100 feet or portion of $87
Phone: FAX: Replacing in-building water supply lines
Residential-first floor $83
Lic.no. 1M 0/1_ 9 //j CCB lic.no. 9 el
each additional floor $32
.............................
Commercial-first five branches $83
Authorized signature: _. ,4„,L _ 01each fixture branch over five $20
Print name: , J. - e Date: 4 Medical gas($ value.) Per fee schedule
�� Applicant lr Contact Person Rainwater harvesting($ value) Per fee schedule
Business name: /^c Roof drain(commercial) $39
- c -P� L.L- Sewer cap $103
Contact name: k4.4 A kikA Sink/basin/lavatory $39
Address: (1IJ 1� <r� 4-1-4p j it Tub/shower/showerrinapan $39
t1 b T� /ii-C' �/ Urinal $39
City/State/ZIP: Do jQi4 6/ () _ q i _ Water closet $39
l0 Water heater/expansion tank $39
Phone: �t�/„/�__e)o(i_ 60,i I FAX: Other $39
E-mail: C lJ l•r ., s S PK ; ey -b�� Plumbing permit fees
Subtotal
Plan Review, please check all that apply Minimum permit fee($5 -7)-
❑Med gas/vacuum system for health care facility ❑Reclaimed wastewater/harvested rainwater system Plan review(25%of permit fee)
U Vacuum drainage waste and vent system ❑Wastewater pretreatment system State surcharge(12%of permit fee) •"Z0
❑Fire sprinkler system U Chemical drainage waste and vent system TOTAL PERMIT FEE
❑Commercial booster pump
U Plumbing related site utilities outside building
U Water service line with inside diameter or nominal pipe size of 2"or more except 2"systems designed/
stamped by licensed Oregon engineer
❑Voluntary plan review
insp_permitapp_plumbing 4/9/18
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
7955 SW FANNO CREEK DR 4, TIGARD, May 23, 2019 at 11 :18:50 AM
OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2019-00213
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor