Permit n CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit#: PLM2022-00095
T[G A R 1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/17/2022
Parcel: 1 S135AB03304
Jurisdiction: Tigard
Site address: 9105 SW OAK ST
Project: Mitchell Subdivision: ASHBROOK FARM Lot: 9
Project Description: Re-pipe of water lines and water service
Contractor: OWNER Owner: MITCHELL, JARED J &HANNAH
9105 SW OAK ST
TIGARD, OR 97223
PHONE: PHONE: 503-890-0177
FAX:
FEES
Quantity Description Date Amount
50 If Water Service 03/16/2022 $62.54
Specifics: 1 12%State Surcharge- 03/16/2022 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 03/16/2022 $9.96
Class of Work: ALT Plumbing
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
Issued By: Permittee Signature: SC-Z- %G
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 `M'E I y C I3
Site Utilities MAR 4 2022
IN ... City of Tigard LA I Y OF I IGAHU n&eZ °E 1(pkZ.Z % J Permit N,,. zoZZ-(jpClc
• 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
Other Permit No.:
= Phone: 503.718.2439 Fax: 503.5§ IN(a DIVISION Date/By:
Inspection Line: 503.639.4175 Date Ready/By: t t fire Page 2 for
TIGARD Internet: wwu.ti and-or oc ) �``�Z,Z t
.tigard-or Notified/Method: I �� Supplemental Information
TYPE OF WORK FEE* SCHEDULE
El Neu construction ❑Detna diut,n For special information use checklist.
Description I Qty. I Ea. I Total
IKAdditionialteration!replacement ❑Other: New 1.2•family dwellings line ludes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I t bath 312.70
xl-and 2-family dwelling ❑Commercialiindusu ial
SFR(2)bath 437.78 tin.7g
SFR(3)bath 500.32
0 Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.It.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: q 1 055 S W O -v S� Catch basin or area drain 18.76
-/' Drvwell,leach line,or trench drain 18.76
City/State/ZIP: l l 3,4 OQ , q7 Z.Z 3
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project frame Manufactured home utilities 5(1.(13
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear tt.:So I Page 2 fpZ..5Int
Subdivision: I Lot n. Fixture or item:
Tax map/parcel no: Backtlow.preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
t / l Clothes washer 25.02
ittfe of �ir `` y 2' / Dishwasher 25.02
Wak4C Set Mt- Drinking fountain 25.02
Ejectors/sump 25.02
PROPEEeRTY OWNER I 0 TENANT Expansion tank 12.51
Name: c[o� / (I4'c cl) Fixture/sewer cap 25.02Vet.
1 Floor drain/floor sink/hub 25.02
Address: CU DS SW Qom- 5 Garbage disposal 25.02
City/State/ZIP: l 4.-4 ea /
q7 22 3 Ilose bib 25.02
Phone:I 505) qv) - 0177 Fax:( ) Ice maker 12.51
.APPLICANT 0 CONTAC"I' PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S I Page 2
Contact name: ftA /\/1 f• �cj J Primer 12.51
-° Roof drain(commercial) 12.51
Address: C1j05 S4 04k 5} Sink/basin/lavatory 25.02
City/State/ZIP: 7-i (4 QQ t G't"1 Z Solar units(potable water) 62.54
Phone:I S� (,( c,I 0 01 ^ Fax: t ) Tub/shower/shower pan 12.51
E-mail. JcwCc.�,Dl1hMl'�A Li/&- gw+A,l . Cbeet Urinal {0_
Water closet 25 IL
CONTRACTOR
Water heater _7.5_2
Business name: Water P tP N in'tDWV 56.29
Address: ()tiler: 25.02
City/State/ZIP: Subtotal Soo.SZ
Phone:( ) Fax:( ) Minimum permit fee: $72.50
C'CB Lie.: Plumbing Lic no Plan review (25'k of permit lie)
State surcharge(12%of permit fee) 60.0410
Authorized signature: TOTAL PERMIT FEE 50.Sb
Print name: �� Date: 03/03/2022 This permit application expires if a permit is not obtained within 180 days
after ft has been accepted as complete.
*Fee methodology set to"I 7t1'nunro Building Industry Service Board.
1:1Building(Pemeits(Pt.MU•PerritApp dr. 10A)1109 440-3616Tt IN0✓COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities t,jt . Fee teat Total Square Footage: Permit Fee:
footing drain- 1" 10ff i(i U; 0 to_..000 121.'tu
Footing drain-each additional 100' 37.52 2,001 to 3.6(5) $169.69
3.601 to 7,2(X) $233.20
Sewer-1st 100' 62.54 7.201 and greater $327.54
Sewer-each additional 100' 37.52 u
Water Service-1st 100' k 62.54 a ( Medical Gas Systems:
Water Service-each additional 100• 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54
slim to$5.(Xk).(X) Minimum fee
Storm/Rain Drain-each additional 10i 3,5,_ $5,001.00 to$10.000.00 $72.50 for the first$5.000.00 and$1.52 for
Other ec Ins tions or Fees Qh, Fee tea) Total each additional$100.00 or fraction thereof,to
p and including$10,000.00.
Inspection of existing plumbing or for $10,001.(X)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$1(01.00 or fraction thereof,to
(minimum charge—1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.(X)/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.(X)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: (cot-5 at
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 be Fixture Type Plan Review for Plumbing Installations
Fixture'type for RcpiaCe/
Plan review is required for any of the following.
Work Performed: tapped added Relocate
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
-lacuzzi/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
Cuspidor/Water 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"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Istnntuu ut riser diagram is required tot nev. huildini'
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/Lar -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *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 he paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
l:\Building\Permits\PLMU_PermitApp.doc 2
RECEIVED
Property Owner Statement MAR 4 202
Regarding Construction Responsibilities f1Yo� riUN1
Oregon Law requires residential construction permit applicants who are not licensed with;ttuo
pfNO DIVISION
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
[V I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Jared Mitchell
Print Name of Permit Applicant
a4042. 3/4/2022
nature of Permit Applicant Date
Permit#:
o,�
Address: (---cit—
A.,4(:-AS 5_
Issued by: Date: g 9'
This Copy for Permit Offices
' Information Notice to Owners About
�
**41 )' Construction Responsibilities
a / (ORS 701.325 (3))
i
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors i
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number (BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 97309-5052
Telephone: 503-378-4621 — Fax: 503-373-2007
Website Address:www oregon.gov/ccb
f/property owner adopted 9-2016 This Copy for Permit