Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2014 00366
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/06/2014
Parcel: 2S1 11 BC00300
Jurisdiction: Tigard
Site address: 14415 SW 100TH AVE
Project: Howse/Ornelas Subdivision: TIGARDVILLE HEIGHTS Lot: 18
Project Description: Connect existing house to sewer service. Sewer Reimbursement District#42. Approximately 20'of sanitary sewer
line. Septic tank to be pumped and filled.
Contractor: OWNER Owner: HOWSE, DIANNA L
HOWSE/ORNELAS ORNELAS, STEVE F
14415 SW 100TH AVE 14415 SW 100TH AVE
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503-840-0309 PHONE: 503-840-0309
FAX:
FEES
Quantity Description Date Amount
20 If Sewer Service 11/06/2014 $62.54
Specifics: 1 12%State Surcharge- 11/06/2014 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 11/06/2014 $9.96
Plumbing
Class of Work: ALT
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
or dire uestions • •UNC • calling 503.232.1987 or 1.800.332.2344.
Iss ed By: /P 0, 4 / , Permittee Signature: :
tIiiW
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 RECEIVED FOR OFFICE USE ONLY
City of Tigard Date/By: // 6//y Y Permit No.. 'U'Pp/ 3196
1111 ■ 13125 SW Hall Blvd.,Tigard,OR 9i 6 U ' Phone: 503.718.2439 Fax: 503.5 0 6 2014 Plan Review
Date/By:
Other Permit No.: 4
/V-736 1/
Inspection Line: 503.639.4175
l I CA K ) Date Ready/By: pp f� El See Page 2 for
Internet: www.tigard-or.gov CITY OF WARD Notified/Method: / ! Supplemental Information
TYPE Oft► IN III • ■I FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement gi Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ur 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
/YW c-,- //DO��/� Catch basin or area drain 18.76
Job site address: / �bc/
City/State/ZIP: 776 9--,a O2 974.742$i F otin drain line,ne trench drain 18.76 Page
� Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: /76/4/s'E/QAQ/E�,5' Manufactured home utilities 50.03
Cross street/directions to job site: J Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:-V) / Page 2 (p�,s-
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
Co Am/E e.7- /&c3/,6 ESC E Dishwasher 25.02
5 t A//77972/ S EW4-7Z, Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: �P9Nn/9 /f0u/sE Fixture/sewer cap 25.02
Address: /4/U/�S� /OQ f�- „9..1.--- Floor ge disposal sink/hub ■ 25.02
Garbage disposal 25.02
City/State/ZIP: 77 6-�2A, Q4., 972_i y Hose bib 25.02
Phone:45'3) 9y0 -- 0 ?O • Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: S,f j .1 E 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
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: () fi(f A/C 2 Water P I P m WV 56.29
F�
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( )
Minimum permit fee: $72.50 70/.5-0
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) , 70
Authorized signature: 4J�zr f` TOTAL PERMIT FEE
dQ • sZ ,
Print name: ..2::)/,•9/v4/4L 1/2seG/j:S- Date:,,/,/ // 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.i Building\Permita\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB)
1
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-1g 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 {
,z. Sf✓ 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 fcc$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
h 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
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial at ❑ Any multipurpose fire sprinkler system.
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„ ❑ 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:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Lil' Stinky ,� UN`jO� C
Environmental Service� C OMPLETE SEPTIC SERVICE Jii(�R` Date:
R19631 S.Kolar Dr. �/�
Oregon City,OR 97045 / _l Ph:8y 6 _6361
NOV 18 2014 es ty
Fax:
CITY OF 1i61a MoIaIIa:(503)829-8458 . Oregon City:(503)658-0518
CAMDINGIV IISIM‘i Fax:(503)722-7186 Email:
O1annor Noue..,
9,415 Sw i0oT'"A1't
tt%..N4 O fa-
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PLEASE DETACH AND RETURN WON YOUR REMITTANCE $
50
DATE CHARGES AND CREDITS BALANCE
BALANCE FORWARD
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PAY LAST AMOUNT
X
IN THIS COLUMN
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Terms:The 10th of th o fo o ng rchase.2%finance charge on all past due accounts 24%
annual. In the event this voice is not paid as agreed and the account is placed in the hands of
attorney for collection,then Lil'Stinky Environmental Service shall be entitled to recover its 7hank,You
reasonable attorney fees,in addition to court costs,in any legal action commenced to collect debt.
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14415 SW 100TH AVE, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00366
George Heimos
NOTE: pump receipt provided by lil' stinky environmental service dated, 11/11/14, for
septic tank pumped. Tank filled with crushed rock, pass.
Violation Summary:
Inspector Contractor