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Permit
IllCITY OF TIGARD PLUMBING PERMIT • 3 ' COMMUNITY DEVELOPMENT Permit#: PLM2020-00167 Date Issued: 04/22/2020 T I G A µ P 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102DC01401 Jurisdiction: Tigard Site address: 8960 SW EDGEWOOD ST Project: Underhill Subdivision: EDGEWOOD Lot: 11 Project Description: 100 If of sanitary sewer for existing residence and 100 If of water service. No sewer reimbursement per Mai Quach. Pump and fill receipt must be present at inspection. Contractor: EMMONS INC Owner: UNDERHILL, MARK R& PO BOX 1610 ROGERS, SUSAN LEE SHERWOOD, OR 97140 8960 SW EDGEWOOD TIGARD, OR 97223 PHONE: 971-732-2329 503-648-1242 FAX: 503-648-1244 FEES Quantity Description Date Amount 100 If Sanitary Sewer 04/21/2020 $62.54 Specifics: 100 If Water Service 04/21/2020 $62.54 1 12%State Surcharge- 04/21/2020 $15.01 Type of Use: SF Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $140.09 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. 32.1987 or 1.800.332.2344.� Issued By: �//%LAY Permittee Signature:........"4:7' c 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. E 'Plumbing Permit Application RE]\'EDAPR 7 2020 Building Fixtures 1,014. ul rice: use; °NI.Y Tigard CITY OF DIVISI y Oi' Ilii • 1312s W HallBlv ..Tigard.OR 97223 BUILDING ®IVISlG �� _ - • Phone: 503.718.2439 Fax: 503.598.1960 Plan Re iew ttr�nRD Inspection Line: 503.639A1/5 IWe y/gr 7. See Page Ifor Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE' SCHEDULE NNew construction 0 Demolition For special information use checklist. Description I Qty. New 1-2-family 0Other: -fitttib dweH[oea(includes t�ft.. each Ea. f Total For each utility connection) CATEGORY OF CONSTRUCTION SIR(1)bath 312.70 to 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bethfldtchen 25.02 ❑Master builder ❑Other. Fire sprinkler(_sq.ft.) Page 2 JOB arm INFORMATION AND LOCATION Site utilities: Job site address: BC160^5 Ei)C,EW OO) ,s , Catch basin or area drain 18.76 City/State/ZIP: I I.c 12D 02 (1122,3 Doting leach line,.linear drain age 2 � 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 nI M►-f\Q`441 Rain drain connector _ 18.76 Sanitary sewer(no.linear ft:It ) t Fags 2 102„S4 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.: bj,�,) 1 Page 2 62,54 Subdivision: I Lot no.: Fixture or Item: Tax map/parcel no.: 2S102.0 Co i 4 CD \ Back:ow preventer 31.27 DESCRIPTION OP WORK Backwater valve 12.51 - Clothes washer 25.02 COP N"(CT To S l i/ Ly' S t►u E ' Dishwasher 25.02 SCPC.Ae( W- rtCA Li tit i Q-O&1 frt.t\0.- Drinking fountain 25.02 1.0 (r A L tie- Ejectors/sump 25.02 giE PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: M(kl-V--: . Uk"J_J L RN\L L Fixture+sewer cap 25.02 Address: 8 100 S W �G� .Oe t) S I Garbage drain/floor dispoar sink/hub 25.02 CAL()�� ^1� A a-1 rt.7 Garbage disposal 25.02 City/State/ZIP: T1 tAf L() ©F' -` 1 .L.3 Hose bib 25.02 Phone:(lit ) "73 2-23"LA Fax:( ) Ice maker 12.51 91 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:I_) Page 2 Primer 12.51 Contact name: M It - �U�!�� -I 1 L L. Roof drain(commercial) 12.51 Address: W t( o S W eD c r U.JOQ ) St Sinkibasinllavatory 25.02 City/State/ZIP: t \(Q-D, ©c_ 9j7213 Solar units(potable water) 62.54 Phone:(Ilk ) '732,-23ZO1 Far::( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: (`ARILK-41 lri(e l G CXM,htt_ ,CO M\ Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: L M�L b).5 �e\LEP AL C '- (&C,t C, Water P(ill P €�1 i in -DR'V 56.29 Address: Y Or, >3ox `to 1 0 Other: 25.02 City/State/ZIP: se)Hi WOOp, Op_ on (40 subtotal' 125,0$ �7 `� Minimum permit foe: S72.50 Phone:(rQ71 P/� "\Z4Z Fax:(SO 2 .- 12L Plan review (25%of permit fee) 31 r11 CCB Lic.: "7 3 b4 Plumbing Lic.no.: State surcharge(12%of permit fee) 15 ,0 i Authorized signature: TOTAL PERMIT FEE 11 1,N2 Print name: IvpIQ_j- i.,_ (.)4\4j64.41C L Date: 4 -� Job O not permit appaeatioa aspires Ira permit is obtained ndblo 180 days !, after It has been accepted as complete *Fee methodology set by Tn-County Building Industry Sonies Board. LBuildwg PermitsPLMU-Pamitkpp.doc 10.0109 44046t6T(1002.00M'wEB) • Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-l''100' 50 03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,60I to 7,200 $233.20 Sewer-lst 100' k 62.54 y, ST 7.201 and greeter $327.54 Sewer-each additional 100' 37.52 Water Service-lac 100' ' 62.54 6 2,54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 51.00 to$5,000.00 Minimum fee 372.50 Storm&Rain Drain-each additional 100' 37.52 S5,001.00 to$10,000.00 $72.50 for the first 55,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for 510,001.00 to 525,000.00 $146.50 for the first 510,000.00 and$1.54 for which no fee is specifically indicated 90,00/hr each additional$100.00 or fraction thereof,to (minimum charge—2/2 hour) and including$25,000.00. Inspections outside of nomral business 90.00/hr 325.001.00 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*. Plan Review for Plumbing Installations 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 Baptistry/Font ❑ Any new commercial building with water service 2"and - greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure I� as defined in OAR918-780-0040. -DriveCuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system. -Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye wash Submit 2 sets of plans with any of the above. Floor Drainisink: -2" 3" Isometric or Riser Diagram 4 ❑ 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/Ear non-food related -Bradley - -- -Com/Serv/Litil food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Fitter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building'.PermitslPLMF_PemlitApp.doc 08/04/2011 2 RECEIVED APR 7 2020 CITY OF i lGARD �U�LDING DIVISION City of Tigard • COMMUNITY DEVE O MENT DEPARTMENT 11 .. = Reimbursement District Payment Worksheet T I G A R D 13125 SW Ball Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov This worksheet must be completed by the Finance Department and provided to the applicant to submit together with a completed plumbing permit application and payment for sewer connection and reimbursement district fee, if applicable, by expiration date shown below to the Building Division. FINANCE DEPARTMENT TO COMPLETE: Site Address: 8960 SW Edgewood St,Tigard, OR Reimbursement District #: 31 Parcel #: Amount Due: $no fair share Amount Due Expires On: SRD expired Applicant: Daytime Phone: Email Address: Sewer Loan Processed (journal entry to follow for payment of deferred sewer connection fee and reimbursement district fee,if applicable)* By: Mai,Q' Date: 4/7/2020 Name Printed: Mai Quach BUILDING DIVISION TO COMPLETE: *If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits. Reimbursement Amount Paid: $ Receipt#: SWR#: PLM#: Enter parcel conditions in Accela (check all that apply): El Enter "paid" condition. El Enter "deferral" condition, if applicable. By: Date: Name Printed: Attach this worksheet to issued sewer permit for records scanning. I:\Building\Riembursement DistrictsUteimDistPaymentWorksheet_NoDefer edAccounts_041918.docx