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Permit (10) CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2022-00277 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/1/2022 Parcel: 2S 104DC00500 Jurisdiction: Tigard Site address: 13398 SW BENCHVIEW TER Project: Young Subdivision: BENCHVIEW ESTATES Lot: 5 Project Description: Relocate water closet,and add a walk in shower. Contractor: OWNER Owner: ERIC YOUNG 12547 SW CANVASBACK WAY BEAVERTON, OR 97078 PHONE: PHONE: 503-887-4890 FAX: FEES Quantity Description Date Amount 1 ea Tub/Shower/Shower Pan 07/21/2022 $12.51 Specifics: 1 ea Water Closet 07/21/2022 $25.02 1 12%State Surcharge- 07/21/2022 $8.70 Type of Use: SF Plumbing Class of Work: ALT 35 ea Minimum Fee Adjustment- 07/21/2022 $34.97 Type of Const: Plumbing 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: z; Permittee Signature: y 2C-4 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. f Plumbing Permit Application Building FixturesEIS` [- City of Tigard Received �� �� • 13125 SW Hall Blvd.,Tigard,OR 97223 JUL 2 2022 Date 1. Y' Pe Plan Review s Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: Inspection Line: 503.639.4175 CITY OF TIOpRI) Date ReadY /B loris: ® See Page 2 for Y Internet www.tigatd-Or.gOV ISION Notified/Method: Supplemental Information 1 YPE flF WLRt{ FEE*.,,SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. I Ea. Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CTEGOR :n CAiTRRJH1R SFR(1)bath 312.70 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 El Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 .z JB SiU=Nlt f4RRAIUN'AND:IUATt(31T' Site utilities: Job site address: Catch basin or area drain 18.76 City/State/ZIP: Drywell,leach line,or trench drain 18.76 � 2 Z 3 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: 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: Z O F- p Lot no.:R2tryt ✓J fixture or it. Tax map/parcel no.: Backflow preventer 31.27 DESCiiIPTIOA? OF�'y►'�RK } Backwater valve 12.51 Clothes washer 25.02 Wa Dishwasher 25.02 O Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWNER "'" ❑ TENANT Expansion tank 12.51 Name: i Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 � � �- �� Garbage disposal 25.02 City/State/ZIP: O o / Hose bib 25.02 Phone:( may ) o Fax:( ) Ice maker 12.51 f�A LICANT [] CONTACT PERSON hlterceptor/grease trap 25.02 Medical gas(value:$ ) Pae 2 Business name: � g t Contact name: Primer 12.51 C�+/ q�� Roof drain(commercial) 12.51 Address: /:4S �Y- Sink/basin/lavatory 25.02 City/State/ZIP: R9 s9 Solar units(potable water) 62.54 Phone:( p Fax: :( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 /C 'CZ Water closet 25.02 CONTOR Water heater 37.52 Bus essname: Waterpiping/DWV 56.29 Address: 2 '-Z Other: 25.02 City/State/ZIP: n Subtotal Phone: 2 Fax:( ) Minimum permit fee: $72.50 Plan review (25%ofpermit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: ®fi�/ TOTAL PERMIT FEE Print name: (,(�G Date: e^, Z 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. 1:ABuildingVPermitsVPLMU-PermitApp.doc 10/01/09 440-4616T(10/02/C0M/WE13) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: S Qty., ,Fee(ea) Total Utilities S Aare FdotA,e, X-Vrmit Vee: 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-1 st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service- 1 st 100' 62.54 Medical Gas S stems: Water Service-each additional 100' 37.52 Valuation: toe mit Fee Storm&Rain Drain-1 st 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 Qty. Fee(ea) Total' each additional$100.00 or fraction thereof,to Other us eCtionS�+Dl=Fees 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' ' `tnbin II1S#alli fl6ftg`' 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. -JacuzzMhirl ool Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water idor/Water As irator E] 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" IgometriC or kilselr Dia..,:lr�ill 4„ ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refri .Drains Comments regarding fixture work: Oil Separator(Gas Station Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/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: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 Water Meter Fixture Unit Worksheet for AddidonslRemo�W-M�, VED Please complete the following information: JUL, 2 1 �OZZ Customer Name: �= �c �9�'t- �Il Y OF TIUARD 1VISIoR` 1[LDI 'a 17 Service Address: Street/Suite#: / �' cy til State: D Zip: y�z 2 Phone Number: ^J — Email: ��"�" G , c' �9u/7 Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total. the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x I = x 1 = Bidet x 1 = x I = Clothes washer _ x 4 = f� c�x 4 = Dishwasher x 1.5 = 3 x 1.5 = 1 S'Outside Water Spigot / x 2.5 = 2 i S� x 2.5 = Water Spigot,each add'1 x 1 = /' 0 x I = Kitchen sink �° x 1.5 = x 1.5 = Laundry sink x 1.5 = / , S- x 1.5 = Lavatory(bathroom sink) X I X I = Water closet,,1.6 GPF(toilet) _ x 2.5 =— —�— x 2.5 = Bathtub/whirlpool x 4 = x 4 = Shower stall l' x 2 x 2 Bath/shower combo _Z x 4 = , x 4 = Current Points:' Proposed Increase: -�---_ � Current Points+Proposed Increase= 3 z , S =New Total Points =Required Meter Size Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=3/4" 37.5 and over points= 1" New Meter Size Needed for New Total Points: Cost: $ (see page 1) Current Meter Size per Utility Billing: Cost: $ (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) FOR OFFICE USE ONLY Current Meter Size Confirmed with UB Signature of UB Representative Date 1:/Building/Forms/WaterMeters_070121_Add.docx Page 2 r REI JUL 21 2022 CITY OF TIGAHU Water Meter Fixture Unit Worksheet for Additions/Rentodels/ADUs RlJILDING DIVISION Please complete the following information: Customer Name: r=r, c c9 r't-h —ev Service Address: Street/Suite#: r�L) S.P,Y�? Cit : Ar State: © Zip: Phone Number: Email: 2J",'C ell'VOCI^ bf �- Please fill in the number of each fixture you currently have. Please fill in the number of Fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total. the proposed total. w Fixture Unit Current Point Current Proposed out ''" propow Quantity Value Total Addition Value Total Bar sink x l — x I = Bidet _ x I = x I = Clothes washer _ _ x 4 = c x 4 Dishwasher _ x 1.5 — /+�' x 1.5 — I"Outside Water Spigot % x 2.5 2. v x 2.5 = Water Spigot,each add'1 x I = / o x I = Kitchen sink x 1.5 = /• s" x 1.5 = Laundry sink Z x 1.5 =_ x 1.5 — Lavatory(hathrmm unk) —51 x 1 = O x I — Water closet 1.6 GPF(to8et) 3 x 2.5 = x 2.5 Bathtub/whirlpool x 4 = x 4 = i Shower stall _� x 2 _ ,9 x 2 = — .c. Bath'shower combo �_ x 4 = i o x 4 Z • �'J Current Points: Proposed Increase: Current Points+Proposed Increase= 3 • S New Total Paints =Required Meter Size Meter Sizes: I to 30 points=5/8" 30.5 to 37 points=1/4" 37.5 and over points=1" New Meter Size Needed for New Total Points: Cost: S__­­__ page I) Current Meter Size per Utility Billing: _ Cost: S�w _ tsee page I) New Meter Size Cost minus Current Meter Size Cost (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) FOR OFFICE USE ONLY Current Meter Size Confirmed with till -- Signa2tre of UB Representative+ t:j8uilding/Fnrms/kvarerM t�:_n�7t t_naa.docx Meter will be upsized to%inch at no cost since current fixture units show that meter should already be that size. J Bentley 071822 .. 1 Y 0'- Jill Bentley me- Hi Eric. Yes,no cost to upsize the meter since the current fixture counts show that it should already be a'%inch.Attached is a signed form but feel free to give the building division a copy of this small also And,please contact our office at 503-718-2460 to start service in your name. Kind Regards, Jill (shelhedhers) M-1 JillCay of Tigard-UtiNty Billing Senior Accounting Asst t88Q 8167211 Pa�:ents (503)713.2460�I Main i d--jPV (503{718.2494 13125 SW Hall Bhd. Tigard,OR 97223 Property Owner Statement i n `' Regarding Construct Responsibilities Construction Res p OF Oregon Law requires residential construction permit applicants who are not licensed with ,� iyr tion Contractors Board to sign the following statement before a building permit c�►�br4N6 (i�" r� Construe 9 9 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 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. ,Iq / (f X 0 u/y!6�-- Print Name of Permit Applicant Signature of Permit Applicant Date Permit M Address: Issued by: Date: This Copy for Permit Offices Information Notice to Owners About 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.gov/ccb f/property_owner adopted 9-2016 This Copy for Permit