Permit CITY OF TIGARD PLUMBING PERMIT
s ill
COMMUNITY DEVELOPMENT Permit#: PLM2022-00194
Tr O A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/24/2022
Parcel: 2S104BC06800
Jurisdiction: Tigard
Site address: 14203 SW WALNUT LN
Project: Rocha water heater Subdivision: BAILEY WOODS Lot: 4
Project Description: Owner replacing gas water heater.
Contractor: Owner: ROCHA, MATTHEW P&MELISSA J
14203 SW WALNUT LN
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 05/24/2022 $37.52
Specifics: 1 12%State Surcharge- 05/24/2022 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment- 05/24/2022 $34.98
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: 14 (VGJ 7:' Permittee Signature: T 'Gy "`�-�74
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
Site Utilities FOR OFFICE USE ONLY
Cl of Tigard Received 41 1�i 1
2 g PlateBY: �� 1/4a Penult No.: puny a la i q 1
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
1 Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175 Date/By:
I Re Ready/By: Tuns, ® See Page 2 for
Internet: www.tigard-or.gov Notitied/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑ Demolition For special information use checklist
Description I QtY. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-famlly dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
N,1-and 2-family dwellingSFR(2)bath 437.78
0Commercial/industrial
❑Accessory building El Multi-family
SFR(3)bath 500.32
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: ,�2p3 SW v ��( F L� Catch basin or area drain 18.76
•
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7 t cs .p 0Q.. cfl 7_13 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
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 ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
44..pA a c.v. euS w o:k s -- -1 c Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,P 1.9.. .-TY 2.,,,WINICR 0 TENANT Expansion tank 12.51
Name: Ma AeW ���,_ Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1('I 2o3 �1N W A`Vvtik ( Garbage disposal
posal 25.02
rSOrd Sii2, g 23 Hose bib 25.02
Phone:(c,O3) S-]HI-O j5'o Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name: MDI-`ertt&,W RCC-kkA
Roof drain(commercial) 12.51
Address: It-1203 SW
",:iii_raLhT L.,„,.t . Sink/basin/lavatory 25.02
City/State/ZIP: 1 I rk U12_ a .2.22 Solar units(potable water) 62.54
Phone:(co3) --)cf_0-7$Q Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater ) 37.52 37.62
Business name:
Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 37.162
Phone:( ) Fax:( ) Minimum permit fee: $72.50 --Q,Sc,
CCB Lie.: Plumbing Lic.no.:
Plan review (25%of permit fee)
/� // State surcharge(12%of permit fee) E-.l-.lc'/�Authorized signature: _ K� f, TOTAL PERMIT FEE s-I,a
Print name: IV(1/F-["f11-ey" Q.0C, Date:cir 2.9 (/'22 This permit application expires if a permit is not obtained within 180 days
I after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\PermitslPLMt1-PermiiApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
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
XI 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.
ATTt1 W Rac.WA
Print Name of Permit Applicant
s/(2.- t/22
Signa ure of Permit Applicant t Date
Permit#: �{ 91 -
` ^t '
Address: \ a.G3 � Wl�1`I14 •
\\C{as GP- o� 3
/VU rorr
`tom
Issued by: l v ' Date: 5//q/ca.?
This Copy for Permit Offices
Aullir,
ti Information Notice to Owners About
"'4 Construction Responsibilities
. (ORS 701.325 (3))
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
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.govlccb
f/property_owner adopted 9-2016 This Copy for Permit