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Permit CITY OF TIGARD PLUMBING PERMIT _ I F' COMMUNITY DEVELOPMENT Permit#: PLM2021-00135 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/13/2021 Parcel: 2S109ACO2600 Jurisdiction: Tigard Site address: 13135 SW BULL MOUNTAIN RD Project: NAHM Subdivision: 1992-057 PARTITION PLAT Lot: 2 Project Description: 34 ft.of sanitary sewer to connect existing home to sewer. Disconnecting and reconnecting to new Foran Hills subdivision lateral. Contractor: ROADHOUSE CONSTRUCTION LLC Owner: NAHM, KEVIN I&ALICE S 613 W FOURTH PLAIN BLVD 13135 SW BULL MOUNTAIN RD VANCOUVER,WA 98660 TIGARD, OR 97224 PHONE: 503-869-5112 PHONE: FAX: FEES Quantity Description Date Amount 34 If Sanitary Sewer 04/07/2021 $62.54 Specifics: 1 12%State Surcharge- 04/07/2021 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 04/07/2021 $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: /7 t. i 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 Application 3 �y�Site Utilities 'VE City of Tigard Received / / 11,1 • 13125 SW Hall Blvd.,Tigard,OR 97223 r Date'B n Pe mil No.: o.: Z021 MAR 2 Plan Review /I �' ) �� = Phone: 503.718.2439 Fax: 503.598.1960 ,41/ other Permit No.:DaleBr, V 1 WARD Inspection Line: 503.639.4175 /��❑ Date Read B Internet: wwtv.ligard-or.gov CITY OF TIl7t'11�D Y' y, 4, 721 See Page 2 for Notitied;Method: ,jrfjY / Supplemental information TYPE OF WORK BUILDING UIVISIO V to/ • ) azivi, Q FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. I Total Additionralterationireplacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: I'31'J.,5 5 w lI M4-. Tj 1 , Catch basin or area drain 18.76 City/State'ZIP: / 1�TiS Drywell,leach line,or trench drain 18.76 a.t- c5ve v. o►'(z24 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: " is 8 �� �J /U�'r/ ' Manufactured home utilities 50.03 Cross street/directions o job site: Manholes 18.76 Sail M+. r , , 40 13135 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:7i) / Page 2 (d j Storm sewer(no.linear ft.: ) Page 2 i Water service(no.linear ft.:_) Page 2 Subdivision: t 'F�✓�„ I5 P no.:Lot (t\�QL Fixture or item: Tax map/pared no.: 2c7 j � 1q A_c 2G0c, Back flow preventer 31.27 DESCRIPTION OF WORK "✓ Backwater valve 12.51 1 1 Clothes washer 25.02 �)SG©rtne-v+- ey_'l 1-i Ott ' a' Dishwasher 25.02 Ch-V1 YtD,L ' •4 )' lta1r✓ $ „-1-e.Wl (Ut'7la 1 r 0 d.5 Drinking fountain 25.02 r'rrr q W,,,(((-I- s-1 ( �C!✓(,L(n Ill I'Stt •' iki l�✓tat� • Ejectors/sump 25.02 ,PROPERTY OWNER 0 TENANT Expansion tank 12.51 gs. Name: - 1 GG a N OF };f/,(t Fixture/sewer cap 25.02 _ Floor drain/floor sink/hub 25.02 Address; r_ r t �_ A. a 31 r I~i/ ,azbage disposal 25.02 CiCity/State/ZIP:', tr , . . Ai VA • ' r I .• ,/ 4, 0 ose bib 25.02 Phone:Th 1 F) -- 3$CID Fax:( ) Ice maker 12.51 APPLICANT I CONTACT PERSON Interceptor/grease trap 25.02 Business name: It��✓I Medical gas(value:$ ) Page 2 rlContact name: `l0 ou / Primer 12 51 Address: `, �,Lgr`.�t/JI Roof drain(commercial) 12.51 I' -t Sink/basinrlavatory 25.02 City/Statei7_IP: 'I'I EA , ,[Ie j aill'COlar units(potable water) 62.54 Phone:( ) 'I ( - 64114- (T Fax::_(1 )'8[./ Tub/shower/shower pan 12.51 E-mail: F- 3 Urinal 25.02 1e Icat-e l i hee✓i el t lt(C/ oilt.00 .co CONTgRrA� rOR ` Water closet 25.02 Business name; fvi� G��P / J- I \ Water heater 37.52 ' 1 {/�1 Ct5'1'• 1 Waterpiping/DWV 56.29 Address: ( 11, , 4 r ile- 5IVA / Other: 25.02 City/State/ZIP; Va.v, Co V V ''/Vah IA- °I%a Subtotal 601 .,y Phone:(93) (-.Gt_ Uri. Fax:( ) Minimum permit fee: S72.50 7)-m CCB Lie.: '�ti 3'IK Plan review (25%ofpermit fee) Plumbing Lie.no.: Authorized signature: If jState surcharge(12%of permit fee) �-'70 ( TOTAL PERMIT FEE 47ri do Print name: r L Do J't f�,o I " IC / Date: 11 2'+ 1 2/ 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. 1a11.1R I RTnnnvCnsuwFPI Plufnbini 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-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' V 62.54 6.62,511 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 Valuation: Permit Fee• Storm&Rain Drain-1st 100' 62.54 $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. Fee(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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for any of the following. Work Performed: Capped Added Relocate please check all that apply. y g Baptistry'Font Bath -Tub/Shower ❑ Any 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 ❑ New exterior plumbing site utilities for any complex structure CuspidorWater Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ 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" 4" Isometric or Riser Diagram Car Wash Drain ❑ Isometric riserdiagramisrequired for new buildings Garbage -Domestic-non-food or g 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/Lac -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filler *Note: if the fixture work under this permit results in an Washer-Clothes 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: I-1Rnildin,APrrmits\Pl MI I PermitAnn don