Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00125
Date Issued: 4/4/2022
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S112BD04000
Jurisdiction: Tigard
Site address: 15065 SW 79TH AVE
Project: Muir Subdivision: 1991-096 PARTITION PLAT Lot: 1
Project Description: Connecting existing dwelling to sewer: 120 ft.of sanitary sewer.Septic tank must be pumped and filled.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: MUIR FAMILY TRUST
267 NE 34TH PLACE BY MUIR, DEBRA EILEEN
HILLSBORO, OR 97124 14114 SE MATILDA DR
MILWAUKIE, OR 97267
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
120 If Sanitary Sewer 04/04/2022 $100.06
Specifics: 1 12%State Surcharge- 04/04/2022 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total S112.07
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
',RECEIVED
Plumbing Permit ApplicationAll
Site Utilities MAR 3 0 2022 1'(1R 01'1.1( I. I .. I IN l
City of Tigard vi1 Y OF TIGHRG Daw$y. stata2 TE I'`nniI*O 1210Z72-(!h 12.s
13125 SW Flail Blvd..Tigard.OR s9 NG DIVISION PI"il°1"
I s Phone: 503,718.2439 1'ax: 503. 'rgli(lt neiciRy. Other Prow y No.:S V e 2(22'O:y7S
Inprction Line: 503.63,1.4175
TIGAli' 14or)ntcigN"e:41L: 3 I Th u 0SSeetnePawIllf.rformmlo.Iremel: www.ti anwr.u(e
TYPE OF WORK VMK'111G0 CtOrmi FIFE° SCHEDULE
❑New.construction 0 Demolition For epeeist information astckreldlsx
Description 1 Qty. I Ea. I Total
Kt Additirxt alteration replacement 0 Other. New I.2-famtly dw'elLlge(includes 10011.for each utilityconncction)
CATEGORY OF CONSTRUCTION SFR(I)bah 312,70
'I-and 2-fumilydwelling ❑Commercial/industrial SFR(2)bath 437.7A
FR
❑Accessory building 0 Mulli-Tamil} Eac (3)bath -
500.32
Each additional bath kitchen 25.02
❑Master builder 0 Other Fin:sprinkler( sq.ft.1 Page 2
JOB SITE INFORMATION AND LOCATION Stet utilities:
Job site oddre.v: ,5 0 c 5 5 W -�ot4% Ow c Catch basin Brea drain IN.76
DrywcIL leach time.or tenth drain 18.76
City/State ZIP: "ilA aS,. Ok Footing drain(no.linear R.:_) Page 2
Suile/bidg.iapl.no.: J Project tome: Manufactured home militant 50.03
Cross strcevdirections to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:Lab Page 2
Storm sewer(no.linear II.:_l Page 2
Water service(no.linear ft.:1 Page 2
Subdivision: Lot rx.: Fixture sr hem:
Tax map/perm!no.. Racial**pre%ctnec 31.27
DESCRIPTION OF WORKRarlwoter valve I2.51
``
Clothes washer 25.02
Q'QCY �'ec\ irG e14GAvsc\P GLMar I1/_� _ Dishwasher 25.02
1� � 51t11F. IArtk 6t.W eA \ G- \ "Y('P111/) VAN',
AN', Drinking fountain 25.02
ko `1\11Q. 5'1'►)VD R -No eAeliz 9-43.w. Ejeztoraraimp 25.02
0 PROPERTY OWNER 0 TENANT Expannituu tank 12.31
Nance: Fistura'eewer cap 25.02
Floor draid0oor sink/hub 25.02
Addtcss:
. Oarbagc disposal 25,02
City/State ZIP: lime bib 25.02
Phone.( I Fax:1 ) Ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON InlcrcepWrlgrcase(nip 25.02
Business Merle r'- A4 :Q 41414
Medical gas(value:S_I Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink'baain'lavanuy 25,02
City/Suite ZIP: Solar units(potable watn) 62.54
Phone:1 1 Fox::( 1 Tub'nhawershower pan 12.51
Unnii: inf0 Qb1A4ro�kUncle.rrovnok.coin Urinal 25.02
•
CONTRACTOR Water closet 25.02
•
31 k R f~ 1 tt1 Water heater 37.52
Business name: qL p 1C 04eftrova 11-'L'G Water i t 'DWl' 56.29
Address: r I/�t P P�Mi
O ISO� 5G1 el CIOther: 25.02
City/State ZIP:'-e)coNvexelroyN O CI1 O( Subtotal
Phlnle:4b3 I .7 LI`t .`131z Fax:I )
Minimum permit fee: 572.30
1 M 6S Plan review (u Uf permit to )
C't'D Lie l g (p I l Plumbing Lie.sm.: State surcharge(12%of permit feel
Authorized signature / .' • TOTAL PERMIT FEE
aver N
Pont rank: I ma (Act) e WIC:31Q1 a p�1n YYM permit aypNnliaa sxphx If a past I.tort trd w6Mla IRO dys
Eta Iwo neesyted err matelot.elotylatt.
•Fee methodology eel by TN{000ty Budding Indunry Service bowl.
I.0.11144g P4nw.11.SI••Pnm.a,yy..our I aor m .m-*1tie IhO2.(I:•MWL a1
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Pm ta3 ToW Square Footage: Permit Fee:
Fouling drain-1"100' 5003 0 rn 2,000 S I21,90
Footing drain•each additional 100' 37,52 2.001 to 3.600 S 169.69
3.601 to 7.200 S23320
Sewer In 1(Kr 1 62.54 7,201 and greeter S327.54
Sewer•each additional IOC 1 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-let 103' 6254 S 1.00 to S5,000.00 Minimum fix:S72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to 510,000.00 S72.50 for the fits)55.000.00 and 51.52 for
Other Inspections or Fees ' Fe.ttU T� each additimal 5100,00 or faction thereof,to
P and includingS10.000.00.
Inspection of existing plumbing or for $10.tx11.00 to 523,000.00 5141150 for the lint S10.000,00 and S1.54 for
which ao fee is specifically indicated 90.Wfir each additional S100,0 0 or fraction thereof,to
(minimum charge-I.'2 hour) and including S25.000.00,
inspecting outside of nmmwl business 90.00 hr S23.001.00 to S50.000.00 S379.50 for the lint S25.000.00 and$1.45 for
hours(minimum charge-2 hours) each additional 5100.00 or faction thereof.to
Rcinsprction fees 90.00.'hr and including S50,000.00.
Additional plan review fur revisions 90.00/hr S50.001.00 and up S742.00 for the tint 550.000.00 and$1.20 for
(minimum them:- hour) each additional S100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping.adding or replacing fixtures? If"yea".
•
please indicate work performed by fixture. Failure to
accurately report fixtures could result In increased sewer fees.
(Meaty by Fixture Type Plan Review for Plumbing installations
Flatrre Type for Replace Plan review is required for any of the following.
Worts Performed: Capped Added RINnte
Baptistry/FontPlease check all that apply.
Rath Tub•Shdwer 0 Any new commercial huikling with water service 2"and
-lactuzin Whiripoul greater.except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Dnvc Thru 0 New exterior plumbing site utilities for any complex structure
CuspbSo Water AspiraaK as defined in OAR9 I K-71W-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systeme for health care fuciliticv.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking king Fvurxain ❑ Any complex structure as defined in OAR418-7Ru-0040.
Eye Wash
(Door Drainrslmk .2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Ream
Garbage -Domestic-non-fond ElIsometric or riser diagram is required for new buildings
Disposal -Dan tic-fond related that meet the qualifications above.
-Commercial-loud related
•Indu>trial-food related
Ice MachiRclhg.Drains
Oil sepamtmr(cat Station) Comments regarding fixture work:
Rec,Vehicle Dump Station
Shower -Gang
-stall
Sirdu'Lav -Ncm•food related
-uradley
-Commariel•food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
warer Fxrtucmr increase of sewer EDUs,a sewer permit will be issued and
Water Clues,•Toile fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixturct
i:\auilding ten nita•.P).MU_Rem it Apo.doc 2