Permit v CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit#: PLM2013-00280
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/12/2013
Parcel: 2S102DB00601
Jurisdiction: Tigard
Site address: 8855 SW OMARA ST
Project: Downs Subdivision: BURNHAM TRACT Lot: 8
Project Description: Connect existing house to sewer service,approximately 40'. Septic tank is to be pumped and filled.
Contractor: RIVER CITY ENVIRONMENTAL Owner: DOWNS, MATTHEW JACK
PO BOX 30087 8855 SW OMARA ST
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503-252-6144 PHONE: 503 380-1325
FAX: 503-288-3658
FEES
Quantity Description Date Amount
40 If Sewer Service 08/12/2013 $62.54
Specifics: 1 12%State Surcharge- 08/12/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 08/12/2013 $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 ays of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules ado bed y the Oregon
Utility No' lion Center. •se rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may o•ail a copy of the rules
or dir questions to OUNC by ° •• 503.232.1987 or 1.800.332.2344.
Issued By: ��7 �� r Permittee Signature:
• Call 503.639.4175 by 7:00 a.m.for the next available inspecti• date.
This permit card shall be kept in a conspicuous place on the job site until co pletion of the project.
Approved plans are required on the job site at the time of each inspection.
r1
Plumbing Permit Application
Site Utilities
City Tigard RECEIVED of Ti and Date/ByReceived: / Permit No.: r bav l 2g0
Iiii • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review idlJ J�
C Phone: 503.718.2439 Fax: 503.59> 6) 1 2 2013 Date/By: Other Permit No.:( 2‘9.4915-00177
Inspection Line: 503.639.4175 Date Read /B ®
Juris: See Page 2 for
T I G n K u Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF! MIG DIVISION FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I 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(1)bath 312.70
® I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:8855 SW Omara st Catch basin or area drain 18.76
City/State/ZIP:Togard OR 97223 Drywall,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Downs Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:40) I Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
new sewer hookup
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Matt Downs
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:po Box 947
Garbage disposal 25.02
City/State/ZIP:Canby or Hose bib 25.02
Phone:(503)380 1325 I Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:River city Environmental Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Pat Speer -
Roof drain(commercial) 12.51
Address:Po Box 30087 Sink/basin/lavatory 25.02
City/State/ZIP:Portland Or 97294 Solar units(potable water) 62.54
Phone:(503)2526144 Fax: :(503)2883658 Tub/shower/shower pan 12.51
E-mail:pats @rivercityusa.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Rivercity Environmental Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) ax:( ) Minimum permit fee: $72.50 7A-
CCB Lic.: 147355 Plumbing Lic.no.:26-789pb Plan review (25%of permit fee)
/ State surcharge(12%of permit fee)
Authorized signature:)( TOTAL PERMIT FEE I. tJ
Print name:Patrick Spe Date:8/12/2013 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:\Building\Permits\PLMU-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:
Site Utilities Qty. - Fee(ea) Tom 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' 1 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
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
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*.
Quantltty by Fixture Type Plan Review for Plumbing Installations
R,FYo k Peerform Capper 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 Thru ❑ 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
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
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:
C:\Users\Pats\Down loads\PLM U-PermitApp.doc 2
Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map& tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS-Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
1:\Building\Permits\PLMF-PermitApp.doc 12/30/05
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Scheduled Date ��3
+ Work Order# / r
7U �� :
River City Environmental, Inc.
• P.O. Box 30087 503-252-6144 Complete Industrial
Waste Removal
Portland, OR 97294 OR CCB# 147355 • WA CCB# RIVERCE981BT Septic Tank Cleaning
Sump
t,t) 04 y, /3--0 C.)OZ O Line Cleaning
-'
B / ( i Site Information
Description Units Amount
/i R.✓ . l O
Instructions: Driver Notes •
GC 0-,1 !, ii � `Y?rvICy_
S co iT ;;'
( Ver ece>jo l
River City Environmental, Inc. is in no way responsible for damage to the septic tank or lids on the system.
Terms: Net 10 days. 1.5% per month will be charged on past due accounts. (18%per annum).
Terms and Conditions The Right to Lien
The customer agrees to pay all invoices arising out of pumping services,and any other special services herein within 10 days.
The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered,over and above the
normal servicing schedule,on behalf of the customer.
The customer agrees to assume responsibility damage to customers real or personal property arising from pumping services which take place
on customers premises,where the drivers and vehicles of River City Environmental have been instructed to enter.
This includes,but is not limited to driveways,trees,power lines or poles and building structures
If River City Environmental,Inc finds it necessary to add liquid to the tank on jobsite,customer will be charged for the additional gallonage resulting
from these condidtions.
Customer agrees to reimburse River City Environmental,Inc.for all reasonable attorneys fees court costs and other expense incurred by said
company to enforce collection or to serve their rights under this agreement
Customer agrees to the above conditions. Redeemable in Multnomah County
Work Authorized by _.- �"+ \ \\C) Date / /
Driver Signature Date ri / / Time