Permit CITY OF TIGARD PLUMBING PERMIT
'it• ' COMMUNITY DEVELOPMENT Permit#: PLM2020-00345
Date Issued: 8/31/2020
TfGAR n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S102AD00700
Jurisdiction: Tigard
Site address: 12665 SW HALL BLVD
Project: Salon Natalia Subdivision: None Lot: None
Project Description: Replace 40'of sanitary sewer line.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: MAHER, DAVID J &GABRIELLE N
267 NE 34TH PLACE PO BOX 1317
HILLSBORO, OR 97124 LAKE OSWEGO, OR 97035
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
40 If Sanitary Sewer 08/31/2020 $62.54
Specifics: 1 12%State Surcharge- 08/31/2020 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 08/31/2020 $9.96
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 or 1.800.332.2344.
Issued By:� Permittee Signature: .: r v .
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 Auulicatio E Cr:IIVED
Site Utilities l l ilt a 11 1 it 1 1 s,r ()NIA
City ofTi and AUG 2 i5 2020 Rxe sad
t3I s SW IlIIII!Usti..Tigard,OR 1¢¢7fS{z 11�� r>,a Y ��3/1Z� 40 "�i''`�L>`1 ZO Zo-17t13y
5D3 10 TIGARDY OF fknR. i.�
a Phone' 503 7111.2-0iq Fax 503_ unlit Pcrtttn V..
INtcAW.
In>prteliurtl_inr. 50J.63vA175 QINO DIVISION INUKc.alsnrl �," ® tirePaer2rar
tntcmd: www.ligard-,r4 s Vutel td Aleah W Supptrmental IMW,II Ik n
TYPE OF WORK FEE" SCHEDULE
special a of in ana tor
r chrr•UNrt.
0 Nc. uc cars itiam ❑Demolition
Dem.npbnn -1 (hy- i I:a. [ Total
"Achlicum alleratinn replacement 0 Other: I.I.2-fam)1,s dnalings Uncludes too n.for each utility connection)
CATEGORY OF CONSTRUCTION SIR(I)bah 312,70
0 I-and 2-fermi,d. t:1111 : C onintemial indaNtrial SFR t2l balb A,l7,TF
SFR(3)bads 50t1„12
0 Acccwry bui;dinp 0 Muni-family
F.i.tt aJditiptul Iw011001cn 25,02
tsta.'',0 huildrt 0Other: Fin sprinkler t,sN Ii 1 Page 2
JOB SITE INFORMATION AND LOCATION Sile nMikrs:
Fob silt address; 1 O.G Co5 3 W \APS 1....(... Qj LV t'1 Catch basin or area drain I x 7r.
rJ V Drywall,leach line,ur trench drain 18 76
City)Stalc ziPr 1 S(,-$0%(-0 6%. rowing dram Mo.011 at 0.: ) Page 2
Suitelbldg.ape.no.: .1 Project name: r
Man lactmed home utilities 50.03
Cross street±directions tomb site: Will halt" 18.76
Ruhr drain connector 18.76
a
Sanitary saber too.linear 11.:y, ) I Page 2
Storm sewer(no.linear 0.: I Page 2
Walcr service Inn,linear pr o) Page 2
Suhdnisrun: I Lit MI.- ,Fixture or hem
Tax ma tree!no,'. Back now prctenter 31.27
Nr�
DF:SCRIPTION OF WORK Backwater salts 12.51
4' ors t-- ['� -.`}/�
►pe. bAJ�'SA. s 4 \ c Cqh 1 l OA i7 DishCloi ea her 25.02
1 tt Dishwasher 25.02
l &cA\ F '1' ._ U a Drinking fountain 25.02
Ereclurw'sump 25.02
0 PROPERTY OWNER r ❑ IIA%NI Expulsion tank 12.51
Not"_ Fiature'sswsetcap _ 25.02
Floor drainftlour sink,bub 25,02
Address
----- -- Crarbagt disposal 25.02
cnyM1fale ZIP: -
!lose bib 25.02
Phone:( 1 Fat:t I Ice maker 12.51
0 APM.IA'ANT ❑ CONTACT PERSON Interc-epturlgna strap 25.02
Business name.5 Medical gas'value. 1 Page 2
Pniner 12.51
Contact name:
- - Rood drain(commercial) 12,51
Alkinxs: ,
SutLbitnietasatory 25.02
C'ilyiSIalt ZIP: Solar umtx(potuble.saitr, 62.54
Plante:l I Fr%. l ) Tub'shnwcr shower Pan 12.51
E-mail: \ e,%)41\ ,(A\ti OG14 •'%4314t OttOVY\ast LOYVti Urinal 25.n2
CONTRACTOR
JN Water cline 25.02
` '9 G� * Wale:hearer 37.52
Business name: Ir. �►.p Qt,��s p a.�7y`rp,yva y 1_L C Wares pipingtfWV 56.20
Address. '" v
Other: 25.02
City/State TIP: I,_' tf`o wiz GI•1 lay Subtotal
Phone:i O�) Fa:t• 1 Minimum pencil fee: S72.50
5 '1(�1 °1t3�7. 7Z.sa
Cal Lic.: t 1\O \ � \l y S� I'Iwt rcsitw (2S°self)ferrite Lei
Plumbusg tc,an" J"t
Stare surcharge 112%of pctmit tea I Pr 76
Authorize!signature - ,/,�
l TO"tAt PERMIT fff•
Print_- firm�, rc-�W yf V\ Dak, B\yea\7074 '1Mh pctma applk►i etpt a If a per lmir i.not nMahrd+.11hln Ian dui•
e,J Is VVV Q„� UOw ii tub been acrrpled at rompkrr.
J *1-cc tutln.b.tkYey act by In-(imn:)Htolti g Iwtuuta•SCOoNa Hiked..
I u,,,b°.c l•u.oht•MN(:-Pc,twsm do. to Of au ta,.*u,t ntiu 4 MIN LW
Plutnhin2 Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Q15. Frr/cal Total Square Footage: Permit Fee;
i.,..ian:•da.igi- ( .d,;� 5b11; Otn2Afln 5121.40
I ootinp Lilian•coat d:i,.a,m;J Intl' 3i.5' 2,ti01 h.1,600 51h'1d'i
S.wcr-lit ltnt• 1 1 p2.S.1 r_r.,of 3,4i1! to i,2W $217.20
�P�' '•41I:into meats\ STvt 54
S,ucr-cacti additional loaf 17,5'
\tale Service- 1st 100' 62.54 Medical Gas Systems:
\V4ki Scrvtcc-each additional liar 17.52 Valuation: Permit Fee:
Siam&Rain Dram-1st IOU' 02.54
34.00 of S5.000_00 Minimum fee 572.50
Stone&Rain[rain•eachadJilion:d ;oar )7.5' 55.001AOto510,00000 572.50 for the first 55,O0t1.00 and SL52fur
Other inspectiolis or Fees IJIy, Fee lea) Total each additionalSai00.00a tiuctionthermt,to
and including 510,00000.
Inspection of c%itatng pltunh,ng w q•i SIO,fx1I.IMt In S25.100.0t S l4&50 for the ant$1f.110110I and 51.54 for
which no tee is specifically indicated '$100 hi cult additional Si(kl.nt)or fraction thereof,to
0nimmu:n charge-I'2 hour) and including 525.000.00.
In.pet:to•n.outside of normal lntninsrs 90.001a 525.001 00 to 550.000.00 5170.50 Inv the ti la$25,000.00 and 51.45 for
hoot.(minimum chWttc-2 hours) • each atklitidatat 5100.00 or traction dan•+d,to
Rcinyt•cntm I 00001*1 and including 5500(al Oft,
Additional plan mu tor rrvi,iuns 90.QD tot 550,INII.IN1 and up S742.00 for the first 15t1,1MMI(Mt anti S1.20 far
imminnmt chines: - I.'2 howleach additional S100,00 of huciion thaw(
Subtotal:
Commercial Fixture Work:
Arc you cupping.adding or replacing fixtures" if"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result In Increased sewer ices*.
Qvattllf)tit Fissure Trpe Plan Review Tor Plumbing installations
Fissure Typr for Replacer flan rcricty is required for any of the following.
Work Performed: C'agpr,l Added aclocatr
napr+mlFunt F'lease check all that apply,
taw •7ub5hotver 0 Any new commercial building with water service 2"and
lucuzzi Whnrlpuut greater,except systems designed and stamped by licensed
Car Wash -Luck Stall engineer.
•Dove flub 0 New exterior plumbing site utilities for any complex structure
Cuspidor Water Aspirana as defined in OARY I M-7Su-0O4t1.
pnituAsher -Commend 0 Medical gas and sttcuum systems firr health care facilities.
Dtnuestw 0 Any multipurpose tire sprinkler system.
1)rinkine Couuraia - ❑ Any complex structure as defined in OARY1x.7i40-0040.
I-ye w.uh
fkx,Drairrsink -2'• Submit sets of plans with an of the above.
4 Isometric or Riser Diagram
car Mash Drain
Garbage [Acmrsnr-note-f xtl 0 Isometric or riser diagram is requited for new buildings
fimount -Domaue•tiad related that meet the qualifications above.
-Ctmttnrrcial-\\coca relit d
4ndustrtal-fncd related
lee 4iuch.iRofrig.Drain.
Oil Separator(Gas Station,' Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sittkilatr •Von-road related
•nradicy
-Commercial-loud related _
•Service
Cwirtter pPoolPh art
'tote: if the fixture work under this permit results in an
Washer-clothes
es
Water Escrasn+r Increase of sewer El/Us,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:
t:BuildingJbnnils\PLMtJ_PetttatApp.dtic 1