Permit (3) CITY OF TIGARD PLUMBING PERMIT
IN .
a ' COMMUNITY DEVELOPMENT Permit#: PLM2022-00400
Date Issued: 10/3/2022
it G;A R I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 110BA04301
Jurisdiction: Tigard
Site address: 14310 SW MCFARLAND BLVD
Project: Leask Subdivision: SHADOW HILLS Lot: 22
Project Description: Replacing water line from meter to the house.
Contractor: Owner: LEASK, LISA A
15532 SW PACIFIC HWY#C18
PORTLAND, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
50 If Water Service 10/03/2022 $62.54
Specifics: 1 12%State Surcharge- 10/03/2022 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/03/2022 $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 of started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you ,"followt rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y may obt ' a copy of the rules
Issued By: -''h. , ����// /J Permittee Signatur .
(%'�� 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
Building Fixtures FOR OFFICE USE ONLY
City Of Tigard Received f Permit No.: 0Li}1 (r, `GC �i.yk'`
Date/By:tC1/ Z�`
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready By: Juris ® See Page 2 for
Internet www tigard-or gov Notified/Method Supplemental Information
FEE* SCHEDULE $7-
TYPE OF WORK _
❑New construction 0 Demolition For special information use checklist
Description
( Qty. I Ea. I Total
%Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
,.. . ter: SFR(1)bath 312.70
CATEGORY OF CONSTRUCTION
JJ-and 2-family dwelling ❑Commercial/industrial
SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
I 3(0 vy -y ;/�/ �1,14) Catch basin or area drain 18.76
Job site address: i //
q (� Drywell,leach line,or trench drain 18.76
City/State/ZIP: 6-ft-n-D 0/Z-. ! "7 Z Z7 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: /� Manholes 18.76
it Li. W OttiNM•II✓ RU 7 w c c//(2 Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:4 D) Page 2
Subdivision: S tilt-1:8 t / (^'( ((-(..5 I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.: 12 51
..., �• 1 ,� Backwater valve
...dtr' i^ ;x P, u.l E t -,t ize ,14.,r r,? •
e r
wa,..1 -4. .: -. Clothes washer 25.02
p-r,P Lilt Y 1/i-H✓ (Al i-77=./2.- L-I Dishwasher 25.02
F(ZD AA W i%T >7.2- TO / 6 r ' Drinking fountain 25.02
Ejectors/sump 25.02
- ROPERTY OWNER 1 0 TENANT Expansion tank 12.51
n Fixture/sewer cap 25.02
Name: DO r-i 1 t.,( - +' L_.A. -1L- 25.02
Floor drain/floor sink/hub
Address: 5ii--ryt 6 Garbage disposal 25.02
City/State/ZIP: I/1 ,,r Hose bib 25.02
Ice maker 12.51
Phone:(lj p3) "7 Fax:( ) Interceptor/grease 25.02
❑ APPLICANT El CONTACT PERSONtrap
Medical gas(value:$ ) Page 2
Business name: 12.51
Primer
Contact name: (dJ 0R41_ 8 ti °LA.)f-foi2 Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax:
Tub/shower/shower pan 12.51
( )a�� I, Q=/CT_ Urinal 25.02
E-mail: ( � l'� w)d,'/L• (✓9V►n Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: 0 /`-"S1z Water piping/DWV 56.29
Address: Other: 25.02
Subtotal
City/State/ZIP:
Minimum permit fee: $72.50
Phone:( ) Fax:( ) Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee)
Authorized signat>/"----�e,� '-�. TOTAL PERMIT FEE � ,){Print name: Dal,/ L .iiiL Date: /0 --3 2.a 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.
I:\Building\Permits\PLMU-PermilApp.doe 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:
Sicipar ,F9lotagc . 1'emit Fee:
Footing dram 151 100' 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 Systems:
Water Service-each additional 100' 37.52
'�a�uatton. `Permit Fee:
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
4 r i t t each additional$100.00 or fraction thereof,to
. , .ram F 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*. I R�le xiiiii ;i , 1414°ll4iat
Quantity byFixtureType 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.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Wrator 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator Cp al El Any multipurpose fire sprinkler system.
Dishwasher.
Domestic ❑ 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" Isometric or Riser Diagram
4" 0 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./Refrig.Drains Comments regarding fixture work:
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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
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
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.
Print Name of Permit Applicant
L '
- 2?
/10 3
Sig ermit Applicant Date
Permit#: .1
Address:
itulrrv�;i
Issued by: Date:
This Copy for Permit Offices
�' ' information Notice to Owners A out
�.,�yq j_t s MI a a •
i .,,V ' o str ct 0r Responsibilities
�`ti_k (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, call 503-945-8091 or go to
http://www.oregon.gov/DOR/BUS/docs/211-055.pdf for the appropriate forms.
•' 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 503-947-7815.
•, 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, call the IRS at 1-800-829-4933 or visit their website at 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 9-23-08 This Copy for Permit Applicant