Permit CITY OF TIGARD PLUMBING PERMIT
•
IA s COMMUNITY DEVELOPMENT Permit#: PLM2021-00279
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/1/2021
T I�°r�A,L7 9 Parcel: 2S 102BC03300
Jurisdiction: Tigard
Site address: 13035 SW WATKINS AVE
Project: Seinwerth Subdivision: ROSE TERRACE Lot: 7
Project Description: Connect existing dwelling to public sewer. Septic to be properly decommissioned.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: SEINWERTH, DANIEL TODD&THERESA MARIE
267 NE 34TH PLACE 13035 SW WATKINS AVE
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 06/30/2021 $62.54
Specifics: 1 12%State Surcharge- 06/30/2021 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 06/30/2021 $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: J / Permittee Signature:
JJ 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 Annlien CEI V ED
Building Fixtures JUN 2 4 2021
City of Tigard Recehed
a I3125 SW Hall Blvd.,Tigard,OR 9¢j1TY OF TIGARD Dreale: Z I "c AOT L�1 Zo 2!-d p.27�
Phrase: 503.7113439 Fat: 3t13151,9MNG DIVISION t M oft,Pant'SlaX(,)R..26)24-oil 5
I t c - I' . Inspection Lam: 503.639.4173 Issk RlalhdFty, -I lisp. 0 Rae Tye 2104
Irncncl: www.ligard-or.gos IylrlifwdlAicrMr 9�Jf/�� 4 &j pka..ala iarmadas
TYPE OF WORK FEE*.SCIIEINlLE
❑New tortsl:act ion 0 Demolition For special fn/orararltur rue eAarNlsc
,�1 Arklitirm.'atternlistn±n lacrntent Description 1 ()ly. I Fa. I Tood
ya. p ❑Other: New 1-2-family dneglrg+lincludea I DO It for each utility connection)
CATEGORY OF CONSTRUCTION SFR 0)bath 312.70
Al-and 2-family dwelling 0 Canmtrtiabindustrial SF1t(:)bath 437.78
❑Accessory building 0 Multi-family SFR(3)both S .32
25
Each additional bathicitchen 23.02
❑Master builder ❑Other. Fire sprinkler sq.It.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilltles:
Job site address: '30 3 5 s' ' W W'rsx'N S Ave Catch basin or area draina 18.76
C'itv/Stak+ZIP: �'t A C d1 t 0 R Drywall.leach line, trench drain 18.76
t1 Footing drain(no.linear tl.:_) Page
Suile/bldg'apt.no.: I Project MUM: Monufw.Yurcll home ulititi a 50.03
Cross strectAirections to job site: Manholes 18,76
Rain drain connecter 18.76
Sanitary sewer(no.linear R.:1,011 , Page 2
Stolen sows-Out.t.limn It:_1 NO_'
Water servile(no.lima tic:_) Page 2
Subdivision: I tor QMFitlureorHeat
Tax maprpa eel no.: Back Flow - 31.27
A'F.9CRIPTION OF WORK 6 r(• GO/Milk, ov.taX Backwater valve 12.31
s ,� f lobes miller 25.02
O ry er% Is'1'e1A i r40,%1 Al VNek SA+n°A-At y I/absentll:r 25.02
:j ``Cu.N 1AccCo -T-ca% i Y .. V' co is 4Q +�eL Drinking fountain 25.02
+fV1AtHs.11hw, b1N'�' k/c-SDI ,rAa4. Err e. Ejectonhump 25.02
r-�0 PROPERTY OWNER y` 0 TEN (r ` Expansion tank 12.51
Namc: cw.\�.\ .._7 a art W Q..,c"1 i+k I'iituralsrwer cap 25.In_
Floor drain/law sinkihub 25.02
Addrenx; Garbage disposal 25.02
City/Slate"ZIP: Hose bib 25.02 V
Phone:I ) FOE I ) he maker 12.31
0 APPLICANT 0 CONTACT PERSON I Intt++:tptar/grease trap 25.02
Business r unl: Medical gas(value:S ) Page 2
Primer 12.51
Contact name:
Root'drain(commercial) 1231
Address; Sink l aairsAavatory 25.02
City/State'ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( I Tubrdmwrxlabower pan 12.51
E-nwil: lIA*06) 1)1ALItxocAf.tiblatflfOWI'1a+GOrY1 Urinnl :3.02
CONTRACTOR J Waal Basel 25.02
l Water heats. 37.52
Busirossnalnc: $1Atk (Lb CV. VYIin[OCJY1Gt1LLC• Niter Din /OWN' 56.29
/ �-7 i �JJJ P P� 8
Address', soli I NC �- }+� ,1 t�\t_, thlarr: 25.02
CitylState''Zlr. WA sbpr0 0' 'Vi \9,1{ Subtotal
Phone: t 1141,p bt1 Minimum, nail fee; 572 50
I h :( ► ) 1 Fax: I Pion nice° (25`.ofpermit feel
CCIi I Ic.: 1 "1 b 1 ll Q Plumbing I ic.no.: N 1-155
1 Saw surcharge(12%ulpcnnitrev)
Authori,ed signedute: ,,,,y • 'r tYll'AL PERM II'FEE (p m.r L )
Prim manic; Dr. v+(! TMh penalapplkatleo tapirs'tr a arson*le nix dn.hrd alikla Ias day+
r Ip (, �,� Dale: a �311611 slier II Ina hem steepled as calgdele.
•1'n ms4Mdnlopy at$by 7ei.Cuunly hooding Indlwat Sell ke Want
1:'JMualnar.nie.-l9Atl.ISrema a Sin' 14.1,1 r/a 417.+,Itttl tbO.UJM'Vol'III
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee OW 'rota Square Footage: Permit Fee:.
Fowling drain-I"100' 50.03 0 to 2,000 $121.90
Touting drain-each additional 100' 37.52 2.001 to 3000 SIF9.b9
Sewer•1st IOWR?.5!
3001 to 7,200 $233.20
']fs5, 7.201 and wearer 5327.54
Sewer-each additional 100' 37.52
wafer Stxvicc-1st 100' 62.54 Medical Gas Systems:
Water-Semite-each additional 100' 37.52 Valuation: Permit Fee: . ..
Storm 14 Rain Drain-1st 100' 62.54 $1.00 to 55.000.00 Minimum fee$72.50
Sloan&Rain Drain-each additirul 100' 37.52 $5,001.00 to S 10.000,00 S72 50 for the fist$5,000.00 and 51.52 far
Other Inspections-or Fees Q'y'• (no Thal each additional S100.00 or fraction thereof.to
and including SI0.000.00.
Inspection of existing plumbing trfur S10,001.00In525,000.00 S1411.50 for the first$10.000.00 and$1.54far
which no fee is specifically indicated 90.001a each additional S100.00 or fraction thereof.to
(minimum charge— n hour) and including 525,000.00.
Inspections outside of nattnal business 90.004a s25.00i.o0 to S50.000.00 S379 50 for the first$25.000.00 and SI.45 for
hours(minimums charge—2 hours) each additional$100.00 or fraction Ibcrcof.to
Rcinsprction Fees 90.001r and including S50,00000..
Additional plan review for revisions 90.00/r S30.001.00 and up S742.00 for the first$50.000.00 end S1.20 for
(minimum charge—I/2 hour) oath additional SI00.00 w fraction thereof,
Commercial Fixture Work:
Arc 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 Mature Type Plan review is requind for any of the following.
Flamm Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Aytistry'Fum 0 Any new commercial building with water service 2"and
grealer,cacept systems designed and stamped by licensed
Haile -1uh:Showcr
-lacuvowhirlptxd New exterior
Cur Wash; -Each Stall 0 New exterior plumbing site uliliti,n,for any complex structure
Drive Tlttu as defined in OAR918-7811.00.0.
Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Ctarunminl ❑ Any mttltipurptue lire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR9I i-780-0040.
Drinking Fountain
liy.e Wash Submit j sets of plans with any of the above.
flow Drainsink:
Isometric or Riser Diagram
4., 0 Isometric or riser diagram is required for new buildings
-Car Nash Drain
Garbage -Domestic non-rood Mai meet the qualifications shove.
Disposal. -Dwnestie food related
-Commercial food related
-tndustnat rood related
Ice Mach/Perna Drains Comments regarding fixture work:
Oil Separator twat Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lave bar mat-firth raged
-nradlcy
-CmwSm/Util food reialed
-Sol ice mote: lithe fixture work under this permit results in an
Swimming Ponl Filter increase of sewer EDUs,a sewer perm!'will be Issued and
N'anht7-Clothes fees assessed fur the sewer Increase must be paid before the
water r
Clossct-et-Toilet p lumbin g permit can be issued.
wince CIt>
Urinal
Other Mixtures
!Mudding .iF_PcrtnilApp.dae OW04/2011 2
Dianna Ornelas
From: #Building Permit Technicians
Sent: Tuesday, June 29, 2021 5:40 PM
To: Black Rock Underground, LLC
Subject: PLM2021-00279 & SWR2021-00175 - Seinwerth - 13035 SW Watkins Ave.
Attachments: PLM2021-00279.pdf; SWR2021-00175.pdf
Hello Drew,
These permits are ready to issue and the balance due is shown below (see attached invoices):
• PLM2021-00279-$81.20
• SWR2021-00175-$5,835.00
The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number under the Building tab. Payment can be made by'card'for a 3%service fee or select the 'check' payment
option and there is no service fee.
Please note that the sewer permit SDC fee must be paid prior to issuance of the plumbing permit.
Please email the permit technicians at TigardBuildingPermits@tgard-or.gov once the fees are paid so that we can
issue the permit and email a copy to you.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
1