Permit (2) CITY OF TIGARD PLUMBING PERMIT
.74
s COMMUNITY DEVELOPMENT Permit#: PLM2023-00051
T f G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/25/2023
Parcel: 2S103DC00811
Jurisdiction: Tigard
Site address: 13675 SW 114TH AVE
Project: Brooks Subdivision: VIRGINIA ACRES Lot: 9
Project Description: New sewer connection for existing dwelling. Septic tank to be pumped and filled.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: BROOKS, CHRIS&CASSIE L
267 NE 34TH PLACE 13675 SW 114TH AVE
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 02/21/2023 $62.54
Specifics: 1 12%State Surcharge- 02/21/2023 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 02/21/2023 $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 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: -� ; +s i, 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.
CITY OF TIGARD SEWER CONNECTION PERMIT
114
s.. COMMUNITY DEVELOPMENT Permit#: SWR2023-00035
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/27/2023
Parcel: 2S103DC00811
Jurisdiction: Tigard
Site address: 13675 SW 114TH AVE
Project: Brooks Subdivision: VIRGINIA ACRES Lot: 9
Project Description: New sewer connection for existing dwelling. Septic tank to be pumped and filled.
Contractor: Owner: BROOKS, CHRIS&CASSIE L
13675 SW 114TH AVE
TIGARD,OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/26/2023 $6,625.00
Sewer Inspection-Residential 02/26/2023 $35.00
Type of Use: SF
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $6,660.00
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. I
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
City of Tigard Received en
'J( Z Per nit No.: _ 1. 't -.1 , o SI
III13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: [ ,�. '"} �+3 x CJV
i Phone: 503.718.2439 Fax: 503.598.1960 plan Review
.- Date/By: Other Permit No..
f I G A it it Inspection Line: 503.639.4175 Date Read/B ePage2��a 3 ��
Internet' www.tigard-or.gov y Y iota, See Page 2l for
S
Nu[ified/Method: Supplemental information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description 4 Qty. i Ea. ,I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
.2 I-and 2-family dwelling SFR(2)bath
q Y g ❑ Commercial/Industrial 437.78
❑Accessory building El Multi-familySFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND- U 1 LOCATION ION Site utilities:
Job site address: 13 G 7 5 S la] ► f ve Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1 1
�1 q eNCt\ 1 o --- Footing drain(no.linear ft.: ) Page 2
Suite Bldg./apt.no.: J 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.:)od) i Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Cl\rf LA .%OYW\ 0/Ac 1X 1P15AA1` '1W o),\ni5 Clothes washer 25.02
ll Dishwasher 25.02
'xWEr' \a.�et�wN ,(bYh ono y ex,51� 6L
\ ` VN�Q, �10 1 rq yJ Drinking fountain 25.02
.- Rrs.mrn�1,,e -\ l\ ., \yN 0T`Iil�, �j `Q,�`(`Qps, �J Ejectors/sump 25.02
L'J PRORTY.OWNER -O"'4`M"C�3' �'AO.014,F Expansion tank 12.51
Name: Fixture/sewer cap 25.02
__- - 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
❑ APPLICANT. ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address:
Sulk/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: \ \ANLIg.4-ac\r,,k)144&-oTo‘sac.-ow\
Urinal 25.02
CONTRACTOR Water closet 25.02
1 Water heater 37.52
Business name: 3 k �Ok C R.'1`Q1M.IV Dr(L-L C Waterpiping/DWV 56.29
T
Address: b 60X s 0\5,4 (] v Other: 25.02
�QAjs1P,
city/State/7IP: r (\ d RZ 00c, Subtotal
Phone:(Q1:5 ) 'I y'l Q 2,a Fax:( ) Minimum permit fee: $72.50
CCB Lie.: '(] (0 S\' iw_IIs r Plumbing Lie.no.: Pe,tq Plan review (25%of permit fee)
_F ,tRfL\.�J-1 State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE c(5110
Print name: D x ` ,, 1 f\(, ft Date: 2\`�''Z0 This permit application expires if a permit Is not obtained within 180 days
p"^ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Huilding1Permits\PLMU-PermitApp.doc l0/O 109 440-4616T(10/O2'COM/WEB)
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Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee lea) Total Square Footage: Permit Fee:
Footing drain-I"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 a 2 419. 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
Storm&Rain Drain-1st 100' Valuation: Permit`Fee:
62.54 S I.00 to S5.000.00 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
Other Insertions or Fees Qty. Fee tea) Total each additional$100.00 or fraction thereof,to
and including$1.0,000.00.
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
Remspection 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Perform ed: capped: Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thtu ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3„
4 Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
SinkfLav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\BuildinglWebPageForms\PLMU_PermitApp.doe 2
Karen Abdill
From: chris brooks <brooks50forlife@yahoo.com>
Sent: Friday, February 17, 2023 8:08 AM
To: Karen Abdill
Subject: Fw: Fwd: Order Receipt 10467561
Sent from Yahoo Mail for iPhone
Begin forwarded message:
On Thursday, February 16, 2023, 8:40 PM, Cassie Brooks <brookcfam@yahoo.com> wrote:
Sent from my iPhone
Begin forwarded message:
From: PayGov<no-reply@paygov.us>
Date: February 16, 2023 at 8:39:41 PM PST
To: brookcfam@yahoo.com
Subject: Order Receipt 10467561
This email is a confirmation of your Online Payment for PERMIT CENTER
Cardholder Name: Cassie Brooks
Telephone : : (503) 863-7541
Credit Card Type :Visa
Last 4 digits :4XXXXXXXXXXX0538
Confirmation Number: 10467561
Card Auth Code : 05876D
Transaction ID : 2098417591
Agency Payment Amount : $81.20
Convenience Fee : $2.44
Total Amount Charged : $83.64
First Name:Cassie
Last Name:Brooks
Your payment to PERMIT CENTER has been processed by PayGov, LLC.
NOTICE.Two charges will appear on your credit card or bank statement.
One is for the Tax, Fine, or Fee owed to the government agency and will reflect the
name of the agency.
The other is for the convenience fee assessed by PayGOV.US and will reflect
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For questions or concerns contact PayGOV.US at 1-866-480-8552. Transaction disputes
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