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Permit CITY OF TIGARD PLUMBING PERMIT 1111 s COMMUNITY DEVELOPMENT Permit#: PLM2014-00398 Date Issued: 12/16/2014 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111AB06700 Jurisdiction: Tigard Site address: 9255 SW INEZ ST Project: ALLAIRE Subdivision: PENROSE TERRACE Lot: 12 Project Description: Repairing 10 ft.of sanitary sewer. Contractor: BLACK ROCK UNDERGROUND LLC Owner: ALLAIRE, PATRICK F&BOBBIE M 267 NE 34TH PLACE 9255 SW INEZ ST HILLSBORO, OR 97124 TIGARD, OR 97224 PHONE: 503-747-9312 PHONE: FAX: 503-214-5886 FEES Quantity Description Date Amount 10 If Sewer Service 12/16/2014 $62.54 Specifics: 1 12%State Surcharge- 12/16/2014 $8.70 Plumbing Type of Use SF 10 ea Minimum Fee Adjustment- 12/16/2014 $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 952-001-009.. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3 •• Issued By: r -• '.i•ture Call 503.639.4175 by 7:00 a.m.for the next available ins•action dat: This permit card shall be kept in a conspicuous place on the job site un • . etion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures N819 1 1111 111 I I( 1 I �1 I)vI 1 City of Tigard �C� Received Date/B : .. C / ;ji Permit No.: / Ai v i1„ it,• ;� el 13125 SW Hall Blvd.,Tigard,OR 97223 1 1 " ` A.c Q Plan Review Phone: 503.718.2439 Fax: 503.598.1960 G� 6 Other Permit No.: G Date/By: I I G R l) Inspection Line: 503.639.4175 ` .* I.te.Ready/By: luris: 63 See Page 2 for Internet: www.tigard-or.gov „v�\��i�`ig) tified/Method: Supplemental Information TYPE OF WORK ii • ` IV FEE* SCHEDULE ❑New construction ❑D*,1'1 s n For special information use checklist. Description I Qty. I Ea. I Total R1 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 til 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: Job site address: Clt9 5 .i, tnQ�7 . .r Catch basin or area drain 18.76 City/State/ZIP: i l n G�� Doting leach line,or trench drain Page 2 o` Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: SEL)t R. cze._,Fpc Manufactured home utilities 50.03 Cross street/directions to job site: �'�i� Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: t) / Page 2 G,z .5y 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 ..s., • 4 ' 1.1.a. . 9• ! 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-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_51 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' 62.54 Valuation: Permit Fee: $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 ec Ins tions or Fees Qty. Fee(ea) 'Total each additional$100.00 or fraction thereof,to Inspections 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 engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Stall as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial - ❑ Any multipurpose fire sprinkler system. -Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit I 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 MachiRefrig.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 Filer increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be aid before the Water Extractor p Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\.Building\Petmits\PLMF_PermitApp.doc 08/04/2011 2 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 9255 SW INEZ ST, TIGARD, OR, 97224 Residential - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2014-00398 George Heimos cmoore@blackrockunderground.com Violation Summary: Inspector Contractor