Permit CITY OF TIGARD PLUMBING PERMIT
111 COMMUNITY DEVELOPMENT Permit#: PLM2021-00260
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/22/2021
Parcel: 2S102CD04700
Jurisdiction: Tigard 1
Site address: 9405 SW EDGEWOOD ST
Project: Mitchell Subdivision: 1991-073 PARTITION PLAT Lot: 2
Project Description: 150'of sanitary sewer line to connect existing dwelling to public sewer.
Contractor: CLOG BUSTERS LLC Owner: MITCHELL, MICHAEL H& KIMBERLIE MARIE
2900 SE CORNELIUS PASS RD, STE 549 9405 SW EDGEWOOD ST
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-680-8947 PHONE:
FAX:
FEES
Quantity Description Date Amount
150 If Sanitary Sewer 06/22/2021 $100.06
Specifics: 1 12%State Surcharge- 06/22/2021 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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: // (9.
Permittee Signature:
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 ApplicaticRECENED
Building Fixtures FOR OFFICE USE ONLY
JUN 18 2021 Received
City of Tigard y 2 40 Permit Ncpz ill 2 007 - 0
41 111
13125 SW Hall Blvd.,Tigard,OR 9722 T'?Q ARD w/� 1
Phone: 503.718.2439 Fax: 503.598.1 t/�1 Plan Revie
DIVISIOl'' Date/By: Other Perini[
Inspection Line: 503.639.4175 QUl DING y y
l I G A It U Internet: www.ti and-or. ov Date Ready/By: /2 /, ifJ luris: ® See Page 2 for
g g Notified/Method:, - ..� �u Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Ea Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
14 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
ID Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: l..-Q5 311\> E ,\I\M:O. SA Catch basin or area drain 18.76
City/State/ZIP: '-1--
1 �/�CVJO j 1 "`J`' Drywall,leach line,or trench drain 18.76
"O\ \ V Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: R I?./"G��'GL__ Manufactured home utilities 50.03
Cross street/directions to job site: N V 0 es s\ Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear It.:(50) 2 Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
PP C-b \I"\I\ 5k5Dishwasher 25.02
3 \\\ c\ \^^V SC-VW\C - ktr)i (`\Qu.S 0O C i \ Drinking fountain 25.02
ly\o J� Q,v\O - -ay C`A-{ man a Ejectors/sump 25.02
R 0 PROPERTY OWNER
l 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: -
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
„Q. APPLICANT .4 CONTACT PERSON Interceptor/grease trap 25.02
S� �i Se,� LAC
gas(value:S ) Page 2
Business name:( l
Contact name: l \ Primer 12.51
�c\C \o \V�v�\-- Roof drain(commercial) 12.51
Address:0,1"N00 CbC(NQA\VAS ' 5 Sink/basin/lavatory 25.02
City/State/ZIP: \\,\\\5tu0 t O�0\--"\`2`t Solar units(potable water) 62.54
Phone: 11�\ 1` Fax:: v Tub/shower/shower pan 12.51
E-mail:.--ry Vi ,`(� ®Gl `� �-.rSl�r r� Urinal 25.02
Water closet 25.02
C iTRACTOR
Water heater 37.52
Business name: See QV t
Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone:( ) Fax:( )
Plan review (25%of permit fee)
CCB Lic.:( \a Plumbing Lie.no.:Q. 3
State surcharge(12%of permit fee)
Authorized signature: 47 TOTAL PERMIT FEE r/Z !�'J
t
Print name Z
V Vp Date: � (�''`, , This permit application expires it a permit is not obtained within ISO days
o after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1-\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-46I6T(10/02/COM/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- 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' 62.54 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required For any of the lollowing.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
IDBaptistry/Font Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ 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 Drain/sink: -2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-food that meet the qualifications above.
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: -Lay/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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