Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2021-00142
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/14/2021
T f i;A Id D g Parcel: 2S101AB01602
Jurisdiction: Tigard
Site address: 7310 SW HERMOSO WAY
Project: Gibson Subdivision: HERMOSO PARK Lot: 14
Project Description: Sewer connection
Contractor: ON DEMAND EXCAVATION Owner: GIBSON FAMILY REVOCABLE TRUST
PO BOX 1192 BY GIBSON, CORNELIA& KLAUS PETER
TUALATIN, OR 97062 TRS
10904 SW PARKWOOD CT
WILSONVILLE, OR 97070
PHONE: 503-516-7174 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/14/2021 $5,800.00
Sewer Inspection-Residential 06/14/2021 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,835.00
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 •AR 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 1.80'332.2344.
Issued By: Permittee Signature: v) ,///9
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This •ermit 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 Applicat ECEIVED ,
Building Fixtures J 4 92 FOR OFFICE USE ONLY 1
UN 1City of Tigard v Received c//,f o Z' �� Permit No.: SW,ZW 2I 601 4 2_.
111 Ill • 13125 SW Hall Blvd.,Tigard,OR 97 1T 1 OF TIGARD Date/By: Uo
Plan Review pt 412O��
Phone: 503.718.2439 Fax: 503.5 Other Permit No.: //
Inspection Line: 503.639.4175 ILDING DIVISION DateBy:
I ��;;\��l) Date Ready/By: luris: HI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description 1 Qty. 1 Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:7310 SW Hermoso Way Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, OR 97229 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name:1978-Gibson Manufactured home utilities 50.03
Cross street/directions to job site: SW 72nd Ave Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:99 ) 1 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
41 10::: linmoi. , (I Backwater valve 12.51
', v l f 1 oilki i , i s Y
4 Clothes washer 25.02
Trenching from home to face of curb Dishwasher 25.02
PLM2021-00229 for sewer connection Drinking fountain 25.02
Ejectors/sump 25.02
IRIRIA a .: ;,x .°tu,�x 1 ft
iiiinIi�Pe. d�4`' s t +h oliAllinfini_ + } ," o- t0%p 1' ". t 1 '�44 , fi Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Klaus Gibson
Floor drain/floor sink/hub 25.02
Address:7310 SW Hermoso Way Garbage disposal 25.02
City/State/ZIP:Tigard, OR 97229 Hose bib 25.02
Phone:( ) p��'ppp S Fax:( ) Ice maker 12.51
N 4.G �fy��r 5 x � : St ro: t� ,-
r:�� �7 o, ` {o. c f lr:° �kk�� F Interceptor/grease trap 25.02
Business name:On Demand Excavation LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Ali De Leon Roof drain(commercial) 12.51
Address:PO Box 1192 Sink/basin/lavatory 25.02
City/State/ZIP:Tualatin, OR 97062 Solar units(potable water) 62.54
Phone:(971 )272-7220 Fax: :( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:rs@odexcavation.com
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:On Demand Excavation LLC Water piping/DWV 56.29
Address:PO Box 1 192 Other: 25.02
City/State/ZIP:Tualatin, OR 97062 Subtotal
Phone:( 971) 272-7220 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:221638 Plumbing Lic.no.: PR7241,7 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: 4g Z7 j_zgn- TOTAL PERMIT FEE
Print name:Ali De Leon Date:6/14/2021 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.
I:\Building\Permits\PLMU-PermitApp_doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Q . Fee(ea) A.eitirl. Square Footage: Permit Fee:
Footing drain- I" 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 Ins Qty Fee(ea) Total
eetions or Fees each additional$100.00 or fraction thereof,to
p 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 following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font 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 El 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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