Permit •
f „ CITY OF TIGARD /6
PLUMBING PERMIT
111 COMMUNITY DEVELOPMENT Permit#: PLM2015-00369
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/27/2015
Parcel: 2S111AB03300
Jurisdiction: Tigard
Site address: 9430 SW MCDONALD ST
Project: FRENI Subdivision: ELROSE TERRACE Lot: 27
Project Description: Installing 155 ft.of sanitary sewer and 155 ft.of water service for future partition. 10/28/15 Clarifying description
there are(2)separate service lines each for sanitary&water for U future lots.No connections are done at this
time.Sewer total less than 300',water service less than 300'.
Contractor: OWNER Owner: FRENI,THOMAS E AND
THOMAS&TRACI FRENI LYNNE-FRENI,TRACIE
9430 SW MCDONALD ST 9430 SW MCDONALD ST
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503-314-5893 PHONE:
FAX:
FEES
Quantity Description Date Amount
299 If Sanitary Sewer 10/28/2015 $137.58
Specifics: 299 If Water Service 10/28/2015 $137.58
1 12%State Surcharge- 10/28/2015 $33.02
Type of Use: SF Plumbing
Class of Work: ALT 45 Misc Administration Fee 10/28/2015 $45.00
Type of Const:
Occupancy Grp:
Stories:
Total $353.18
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 enter. 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 • estions to OU = calling 503.232.1987 or 1.800.332.2344.
I.sued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next availabl= mspec••n date.
This permit card shall be kept in a conspicuous place on the job -'e..• • completion of the project.
Approved plans are required on the job site at the time of each inspection. 1
CITY OF TIGARD PLUMBING PERMIT
11 ,,
11 t COMMUNITY DEVELOPMENT Permit#: PLM2015 00369
0
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/27/2015
Parcel: 2S111AB03300
Jurisdiction: Tigard
Site address: 9430 SW MCDONALD ST
Project: FRENI Subdivision: ELROSE TERRACE Lot: 27
Project Description: Installing 155 ft.of sanitary sewer and 155 ft.of water service for future partition.
Contractor: OWNER Owner: FRENI, THOMAS E AND
THOMAS&TRACI FRENI LYNNE-FRENI,TRACIE
9430 SW MCDONALD ST 9430 SW MCDONALD ST
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503-314-5893 PHONE:
FAX:
FEES
Quantity Description Date Amount
155 If Sanitary Sewer 10/27/2015 $100.06
Specifics: 155 If Water Service 10/27/2015 $100.06
1 12%State Surcharge- 10/27/2015 $24.01
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $224.13
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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
C1.-------7 Issued By: Permittee Signature:
i1.1 ■1.,Afj4f/ Ar,..a.
Call 503.639.4175 by 7:00 a.m.for the next avai able'- pection date. /
This permit card shall be kept in a conspicuous place on the job site until completion of th • oject.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
' Building Fixtures FOR OFFICE USE ONLY'
City of Tigard �� Received Wilin NI Permit No.:. • 13125 SW Hall Blvd.,Tigard,O> � 'pOi DateBy: G,/t'1_<� ` ,
Plan Review
Phone: 503.718.2439 Fax: 50 5 1°3 DateBy: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 C� Date Ready/By: Juris. H See Page 2 for
Internet: www'.tigard-or.gov 0 1.`G D q Notified/Method. o Supplemental Information
TYPE OF WO'� C` ,v‘9° FEE* SCHEDULE
❑New construction Cx 34!,''. n For special information use checklist.
Description I Qty. I Ea. Total
❑ Addition/alteration/replacement 1,/ Other:existing sfr New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ID 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
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:9430 SW McDonald Street Catch basin or area drain 18.76
City/State/ZIP:Tigard,Oregon 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site:Driving on SW McDonald Street turn south Manholes 18.76
onto SW 93rd Avenue.Site is on the westside of SW 93rd Avenue(between tax lots Rain drain connector 18.76
3200 and 3100)a flag pole leading to 9430 SW McDonald Street. Sanitary sewer(no.linear 15`, Page 2 MO.05,
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft05 Page 2 i W-a.o
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.:2S111AB-03300 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Installing a driveway on the newly created flag pole-anticipate a partition in Dishwasher 25.02
the future. In anticipation of services needed for a future partition w�to// Drinking fountain 25.02
install sanitary sewer and water pipes undergro d--no work in ROW / Ejectors/sump 25.02
® PROPERTY OWNER II TENANT Expansion tank 12.51
Name:Thomas and Trac, 'reni Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:9430 SW McDonald Street
Garbage disposal 25.02
City/State/ZIP:Tigard,Oregon 97224 Hose bib 25.02
Phone:(503)314-5893 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:Trae' reni
Roof drain(commercial) 12.51
Address:9430 SW McDonald Street Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,Oregon 97224 Solar units(potable water) 62.54
Phone:(503)314-5893 Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: O LO N Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 2.6o,/2
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) _.-
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) y-0
Authorized signature: '�:J /� i TOTAL PERMIT FEF,tI, 0
Print name: Date: i � This permit application expires if a permit is not obtained within 180 days
��/ / . F after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.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) Total Square Footage: Permit Fee:
Footing drain-1P`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' 1 37.52
Water Service-1st 100' 1 62.54 Medical Gas Systems:
Water Service-each additional 100' 1 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan revie is required for any of the following.
Performed: Capped Added Relocate y fllowi g.
Baptistry Pont 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"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings-Domestic-non-food
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/Lav -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:
J:\Data\FRE002-Freni II\Forms\PLMF PermitApp.doc 2
s
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 per mits.
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 a II 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 w ill
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 horn eowner statement is true and accurate.
' I "Aid
Print Name of Permit ••plicant
%LiA.iJ%L/LL /o 7//6
Sig ature of Pe ••lican Date
Permit#: Z../t / S UO3‘?
Address: 51730 St--) �C�l�/�[ � ,♦�'`
Issued by: • Date: l(/41,/S"
This Copy for Permit Offices
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
9430 SW MCDONALD ST, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00369
David Young
150' sections of sanitary sewer and water back from 93rd.
Hook up to city laterals to come, not part of this permit.
Violation Summary:
Inspector Contractor