Permit 111 . CITY OF TIGARD PLUMBING PERMIT
111 ry' COMMUNITY DEVELOPMENT Permit#: PLM2022-00433
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/20/2022
Parcel: 2S101 DB00611
Jurisdiction: Tigard
Site address: 7715 SW CHERRY DR
Project: OVE Subdivision: ROLLING HILLS Lot: 15
Project Description: Sewer connection for existing dwelling:200 ft.of sanitary sewer.Septic tank to be pumped and filled.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: OVE, KARRI & ERIC
267 NE 34TH PLACE 7715 SW CHERRY DR
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
200 If Sanitary Sewer 10/20/2022 $100.06
Specifics: 1 12%State Surcharge- 10/20/2022 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 obtain a copy of the rules
C �
Issued By: Permittee Signat
Call 503.639.4175 by 7:00 a.m.for the next available ate.
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
Building Fixtures e lot owlet: usr. ONLY
City of Tigard (� Cj L V D Receivedy: w'�)/ Permit No.:7 Sn 11.-fb[11 Z
III ,II 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review vW 3/
Phone: 503.718.2439 Fax: 503.598.196tir+T 2 0 2022 DateBy: �1• anerPermit No.: d
UU 11,, f+ PT �a1)aa--(JO i? i
T I G A R D Inspection Line: 503.639.4175 Date ReadyBy: '1y Anis: ® See Page 2 for
Internet: www.tigard-or.gov . s 7 Notified/Method: , ors ,,gg - Supplemental Information
❑New construction D Demolition For special lufonnetion use checklist.
Description j Qty. 1 Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CO/MR,Lt• .a, °" SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE;INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
�a is Sul tAkt% '1 i4+ Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tieeisoa Oz. °az: z
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: II Project name: a OJ E t Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: t_ Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear fl.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
12.51
Clothes washer 25.02
4e.t.".he m- (F.I/01e..e l'rAN ( -t)f j 31%,-, l I VI
Dishwasher 25.02
J Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
----- Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
25.02
.� ❑APPLICANT 'CONTACT PERSON sT " Interco Ptort se g p tra
Business name: - Medical gas(value:$_) Page 2
Primer 12.51
Contact name: ezt L0,4Roof drain(commercial) 12.51
Address: '31 i5 Sw C.kCt%% 'VZ Sinlc/basiMavatory 25.02
City/State/ZIP: ' I&met!,t blt_ gTrz.; Solar units(potable water) 62.54
Phone:($S
`) %%Va wk,1/4 b Fax::( ) Tub/shower/shower pan 12.51
E-mail: E.4.G -.• OVS o\rtl.L1clk. • Co Water Urinal25.02
Water
W closet 25.02
CONTRACTOR
• r Water heater 37.52
Business name: tilt L{� Qo` _ kl t084 tr2.6%..1,47 Water piping/DWV 56.29
Address: I 4r1.4 O 5W Sift,0,.� . , c v sT` - L, Other: 25.02
City/State/ZIP: A`016IN` bre cC+oo--+ Subtotal
Phone:Ea,/ )lt+1i.•e';\Z Fax:( ) Minimum permit fee: $72.50
CCB Lic.:ICt l t Plumbing Lic.no.: Plan review(25%ofpermit fee)
State surcharge(12%of permit fee)
Authorized signatur . e' TOTAL PERMIT FEEL 111,in
Print name: Date: This permit application expires if a permit is not obtained wi a It days
• G l /2O after it has been accepted as complete.
*Fee methodology set by In-County Building Industry Service Board.
i Beildi,glPanuts1PLMU-PamitApp.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:
Qty. Fee(ea) Total Square Foota'e: ,P C„rranit ft`e'
Site Utilities 9 '
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-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 i_it I 4.0 II r,01 .
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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other II1SpectiOn,S,.00 FEES and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to S25,000.00 $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 S379.50 for the first$25,000.00 and$1.45 for 1
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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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-Rgyiew 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 Retu ehe 0 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3•• Isometric or Riser Diagram
-4" El 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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar 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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