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Permit IN CITY OF TIGARD PLUMBING PERMIT :' I. ' COMMUNITY DEVELOPMENT Permit#: PLM2023-00285 Date Issued: 7/10/2023 T I GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: i S135DA02900 Jurisdiction: Tigard Site address: 11400 SW 90TH AVE Project: DUMA Subdivision: None Lot: None Project Description: 5 ft.of sanitary sewer repair. Contractor: OWNER Owner: DUMA, RUBEN S&EMANUELA LIDIA 11400 SW 90TH AVE TIGARD,OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 5 If Sanitary Sewer 07/10/2023 $62.54 Specifics: 1 12%State Surcharge- 07/10/2023 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 07/10/2023 $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. Yo may obtain a copy of the rules 1 Issued By: ,-----7 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. Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY Cityof Tigard Received :'� RECEIVED Other Permit 131 SW Halgl Blvd.,Tigard,OR 97223 By: l L i}3 { Levi �2;) 60, c Phone: 503.718.2439 Fax: 503.598.1960 la&By:Review Other Permit No.: "1 I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-orgov JUL 1 0 9n2? Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE El New construction El Demo OF OF I IGARD For special information use checklist. D fLDING DIVISION Description I Qty. I Ea. I Total ❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 El1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 El Accessory buildingSFR(3)bath 500.32 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: I. (14 o C c ci O l-(7 4j Catch basin or area drain 18.76 City/State/ZIP: i;G' 9 7 (2 Drywell,leach line,or trench drain 18.76 J Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: b f 1)m/.� Manufactured home utilities 50.03 Cross street/directions to job site: l Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: 5-) r Page 2 C Z-5--1 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: l Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Ser.-v/ {/ 3Y.L.JJt4' r y,, t 1/ r S 14. Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWNER El TENANT Expansion tank 12.51 Name: 1, .1 P/C tsts U,i' Fixture/sewer cap 25.02 4©I) Lj r �� �` ,V Floor drain/floor sink/hub 25.02 Address: ^� Garbage disposal 25.02 City/State/ZIP: f Glob- I 122 ] Hose bib 25.02 Phone:603 4_453 CJ -7 74. Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: _ Medical gas(value:$_) Page 2 5',2/'� G S c. /1 2 Primer 12.51 Contact name: 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 E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: 4� 64-- Water 1 m WV 56.29 P P tr/D Address: Other: 25.02 City/State/ZIP: Subtotal 64 .511 Phone:( ) Fax:( ) Minimum permit fee: $72.50 7 cO CCB Lie.: Plumbing Lic.no.: Plan review (25%of permit fee) -- State surcharge(12%of permit fee)j e .�Authorized signature: TOTAL PERMIT FEE g),A Print name: �‘..1 i) ;:.1( 011 I7'l Date: 7 //3fo f23 This permit application expires If a permit is not obtained wit 180 days 111 111 atter it has been accepted as complete. *Fee methodology set by Tr-County Building Industry Service Board. IdBuilding\Pennits\PLMU-PermitAppdoc 10/01/09 4404616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: 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 G 9..�y� 7,201 and greater $327.54 Sewer-each additional 100' 37.52 7 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: 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 Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to p 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 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 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 ElNew exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru Cuspidor Water Aspirator ElMedical 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" Isometric or Riser Diagram -4" ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. 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:1Building\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. vt Print ame of Permit Applicant Signature of Permit Applicant Date Permit#: QG/"i ?VA (-1(-)51'gs— /l�Ot) Sol �� -Avf. -, ~ 'Address: Issued by: / • Date: 7//C.03 14 This Copy for Permit Offices ':*, Information Notice to Owners About Construction Responsibilities \t‘es, (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.aov/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