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Permit (23) I� CITY OF TIGARD PLUMBING PERMIT I Is • COMMUNITY DEVELOPMENT Permit#: PLM2016-00202 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2016 Parcel: 2S103CCO2100 Jurisdiction: Tigard Site address: 12060 SW ROSE VISTA DR Project: Brien Subdivision: COLONIAL VIEW Lot: 16 Project Description: Connect existing house to sewer service,approximately 90'. Septic tank is to be pumped and filled. Contractor: CLOG BUSTERS LLC Owner: BRIEN, KENNETH G& 2900 SW CORNELIUS PASS RD, STE 549 AMACHER,JUANITA HILLSBORO, OR 97123 12060 SW ROSE VISTA DR TIGARD, OR 97223 PHONE: 503-680-8947 PHONE. FAX: FEES Quantity Description Date Amount 90 If Sanitary Sewer 04/13/2016 $62.54 Specifics: 1 12%State Surcharge- 04/13/2016 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 04/13/2016 $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 No -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or dir questions to O C . •: ling 503.232.1987 or 1.800.332.2344. lssu d By: / (2/g07---44. Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available in pection 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 ��i�� Ftllz cIFFIc h: t sl: 0\1.1City of Tigard Received 5`'/ Date/By: /3/4' PennitNo.:Al lo,..Q�� iii 11111 I 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �� Phone: 503.718.2439 Fax: 503.598A 1 3 2016 Date/By: Other Permit No. j l6 I I t \R I Inspection Line: 503.639.4175 Date Ready/By: Juris F3 See Page 2 for Internet: www.tigard-or.gov . ` - `-1 I Notified/Method: Supplemental Information ''':';'4'" . ; ;u .*.- l�,i S F.- k atr * s 3 t ❑New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. I Total I. 'ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) Fu4 € t2t, t ;;3 :t:, (4"p %s=,» s E. SFR(I)bath 312.70 JA-1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 h � 't itl'IONATI©N"-" Site utilities: Job site address: I ZU�DU ( .,\Ip_OSC. V 1S�A "1:-.)rCatch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: -r\/\Aj U I 0 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: 1 Project name: ---7--0,p.,L.I3 Manufactured home utilities 50.03 Cross street/directions to job site: SV\ \2.\%"\- Manholes 18.76 Rain drain connector 18.76 I, l,-- s C.-/_ Sanitary sewer(no.linear ft.:cif)) 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 P, i`iiditti Backwater valve 12.51 Clothes washer 25.02 DSSZ,0.11 flEL�-t � ,St! & T]([),,k) TM-)k_/ Q in d (On fled- 101 1 Dishwasher 25.02 I S-1 hi cNicercx k• Drinking fountain 25.02 Ejectors/sump 25.02 y ✓Y Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 '` :-A? 1ACAjyT F. I COjTA�-"PE * Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 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 .'s ` ' Water closet 25.02 ^ :[, ad °V" a' a 2 „,,,A„,,,.,, r--- iki4'. «,. . , , 4S , t Water heater 37.52 Business name: (11 auS rS Water piping/DWV 56.29 I Address: 2Cl p D \ (`or 11e\1 t.t S --)\ 6„SS I . -* -51jq 4-! Other: 25.02 City/State/ZIP: F\A11S' xi Off- eru2:7, Subtotal 5-0 Phone:(C )��_ $61`{--j Fax:(C1 )5-. ...)"`�[ `l� Minimum permit fee: $72.50 ��. Plan review (25%of permit fee) CCB Lic.: Z0D24Z / Plumbing Lic.no.: t• 4, 1.2)$3 State surcharge(12%of permit fee) 9.7v Authorized signature: r TOTAL PERMIT FEE x „.1 Print name: r , I Date: - This permit application expires if a permit is not obtained within 180 days J ^L' after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:Building,Permits PLMII-PermitApp.doe 10 01 09 440-4616T(10 02 COM WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fireu Systems: # 1 tee) ., , of t �,. . .�� Footing drain- 1" 100'W 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 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 1,1 i, y � ter# ;71. ! 5 w k . F : °a;'vr..„ ....a ,�,.. msa �wAP '`s%., 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 -_ � :' 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 I/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. :' :Plan Revitewv`for P,Ipmbng installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font EIw Any new commercial building ith water service 2' and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial El Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3.. ,isomarc' 4,, ; a$er D to, - 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: -Lay/Bar non-food related -Bradley -Coin/Sery/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\Pennits\PLMF_PermitApp.doc 08/04/2011 2 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ■ Reimbursement District Payment Worksheet 1 , ,, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov This completed worksheet is to be submitted along with payment for sewer connection and plumbing permit application by expiration date below. ENGINEERING TO COMPLETE: Site Address: /,206 a i �a E (// S7 4 pg. Reimbursement District #: 020 ( �F gr-°'Parcel #: 4-•/3.45 Amount Due: $ - 0- Amount Due Expires On: Applicant: Daytime Phone: ❑ Sewer Loan Processed (journal entry to follow for payment) Deferred Accounts (if applicable): Owner: Daytime Phone: Legal Description: Amount To Be Paid: $ Amount To Be Deferred: $ - 0 ❑ Deferral Agreement (signed prior to completion of worksheet) By: ,t5 tm-y Date: y/00 BUILDING TO COMPLETE: gb 4, - J,a, �w, Reimbursement Amount Paid: $ Receipt #: SWR #: PLM #: lJJ Enter parcel conditions in Accela (check all that apply): ❑ Enter "paid" condition. ❑ 'ter "deferral" condition, if applicable. B _ _!i i,<<. Date: Attach this worksheet to sewer permit for records scanning. I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_021014.docx L