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Permit (29) CITY OF TIGARD PLUMBING PERMIT s COMMUNITY DEVELOPMENT Permit#: PLM2016-00239 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/02/2016 Tl�'A i`l`� g Parcel: 2S 111 BCO2300 Jurisdiction: Tigard Site address: 14530 SW 103RD AVE Project: Fantz Subdivision: TIGARDVILLE HEIGHTS Lot: 21 Project Description: Connect existing house to sewer,less than 100'. Septic tank to be pumped and filled or removed. Contractor: ENDICOTT-WOODS ENTERPRISES Owner: FANTZ FAMILY REVOCABLE LIVING TR PO BOX 1537 14530 SW 103RD AVE TUALATIN, OR 97062 TIGARD, OR 97224 PHONE: 503-310-1031 503-625-3525 FAX: FEES Quantity Description Date Amount 100 If Sanitary Sewer 05/02/2016 $62.54 Specifics: 1 12%State Surcharge- 05/02/2016 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 05/02/2016 $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 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 direc estions to . NC b - 'ng 503.232.1987 or 1.800.332.2344. Iss =d By: r Permittee Signature: 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 City of Tigard Received �^6 Permit No.: ■ 13125 SW Hall Blvd.,Tigard,OR 971/0 0 2 2016 Date/By: �' ��/ `tel p�NG--Go�39 / W Plan Review k0n„_-/�-•� Phone: 503.718.2439 Fax: 503.598.1960 Other Permit Nok04,944,-•69/ CITY Date/By: Inspection Line: 503.639.4175 O�^y L 1 I I( A I(I) V 1 �; p i Date Ready/By: loris: ® See Page 2 for Internet: www.tigard-or.gov BUILDING UIDIN Notified/Method: Supplemental Information L G DIVISION TYPE OF WORK FEE* SCHEDULE 0 New construction ❑Demolition For special information use checklist. Description Qty. Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 El1-and 2-family dwelling CI Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 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: 1 !"rl c 3 0 cV(.r, -a 7 Catch basin or area drain 18.76 ��- '' Drywell,leach line,or trench drain 18.76 City/State/ZIP: ferrt, ©� �� Z Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Fr\t,j-}-z Manufactured home utilities 50.03 Cross street/directions to job site: A Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: PO Page 2 6)eq,511 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: 1 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 IVtV et:1_ fib c _Avti.J,s-12 Dishwasher 25.02 Drinking fountain . 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 c t / - Name: �j t�2 j n N-r Fixture/sewer cap 25.02 z'lFloor drain/floor sink/hub 25.02 q? Address: ( -i v Sc*/ ( V3 l Garbage disposal 25.02 City/State/ZIP: -) G.�2��i 6 `7 2 2_9,2_9, Hose bib Phone:( 9 3 i .�� © 3� Fax:( ) Ice maker 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 25.02 Medical gas(value:$ ) Page 2 Business name: Contact name: Primer 12.51 Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 c)--• Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 e2 V ,L'-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: c2.\,6 ti l Ix CQ T Water piping/DWV 56.29 Address: Po 6:3 1537 Other: 25.02 City/State/ZIP u A-Ls1-7-,/, .02 ?7 o'2 Subtotal Minimum permit fee: $72.50 rr�� '55-7:3Phone:(6Z,) ?-p9-0sti � Fax:( ) 701 Plan review (25%of permit fee) --- '- CCB Lie.: 91155-9Plumbing Lic.no.: o��(0�17 State surcharge(12%of permit fee) ?.7� uthorized signature: TOTAL PERMIT FEE 8 .ow P4Arint name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 3- &a s- 35a 5 *Fee methodology set by Tri-County Building Industry Service Board. 67, L Building Permits PLMU-PermitApp.doc 1001 09 440-46161'110 02 COM WFB) 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 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*. 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 El 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 111 New exterior plumbing site utilities for any complex structure Drive 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 El 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- 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: -Lav/Bar 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_PernitApp.doc 08/04/2011 2 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT INi I ■ Reimbursement District Payment Worksheet , ;, ; ,,; ,) 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. --PIA-,6 ULE.2_5 f- NeArr` ENGINEERING TO COMPLETE: 7`ham`cT- 14-3 Site Address: ` (.�5''-&�j �tc 103-41l4 0C--- eAcP,2€D oN 6�aa71, Reimbursement District #: 13 Parcel #: a 5/ '1 73 Oa,3Dd 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 P 4- -: Legal Description: Amount To Be Paid: $ Amount To Be Defe -a: $ ❑ Defer • • greement (signed prior to completion of workshee By: f.-3 Date: S' 2. '4-6 BUILDING TO COMPLETE: Reimbursement Amount Paid: $ Receipt #: SWR #: PLM #: Enter parcel conditions in Accela (check all that apply): ❑ Enter "paid" condition. ❑ Enter "deferral" condition, if applicable. By: Date: Attach this worksheet to sewer permit for records scanning. I:\Building\Riembursement Districts\ReimDistPaymentWorksheet 021014.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14530 SW 103RD AVE, TIGARD, OR, 97224 April 4, 2018 at 12:33:48 PM Record Type: Record ID: Residential - Plumbing PLM2016-00239 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS - NoCofO Comments: Connection to house verified. Copy of invoice/Pump receipt received. Violation Summary: Inspector Contractor