Permit (147) CITY OF TIGARD PLUMBING PERMIT
I.#' COMMUNITY DEVELOPMENT Permit#: PLM2018 00130
Date Issued: 03/27/2018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103CA00212
Jurisdiction: Tigard
Site address: 13140 SW HOWARD DR
Project: CALLAWAY Subdivision: WOODCREST NO.2 Lot: 24
Project Description: Connecting existing house to sewer: 100 ft.of sanitary sewer.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: CALLAWAY, KEVIN J
267 NE 34TH PLACE 13140 SW HOWARD DR
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE:
PHONE: 503-747-9312
FAX: 503-214-5886
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 03/27/2018 $62.54
Specifics: 1 12%State Surcharge- 03/27/2018 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 03/27/2018 $9.96
YP Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 189 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: tg9._
Permittee Signature: ,'e �—r/„ ` ` -- -� .
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
"`a"" . f eceived
City of Tigard i\I� Date/By: 3 611 ai$ _ PermitNo.: n d'T�i i 30
IAII 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �f'
_ Phone: 503.718.2439 Fax: 503.598.1960 yxAn 2 7 ?018 Date/By: Other Permit No.:560e...20 i� _,11,0-152‘
Inspection Line: 503.639.4175 wi'“ Date Ready/By: funs. 65 See Page 2 for
TIC ARD Internet: www.tigard-or.gov . r4 otified/Method: Supplemental
Information
mation
i oi- � v „
'. TYPE OF WORK 011I1fSih FEEHEbuiE
mk1 :ry
,
❑New construction 0 Demolition For special information use checklist
Description I Qty. Ea. Total
❑Addition/alteration/replacement Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
` SFR(1)bath 312.70
ATE(ORYrOFONSTRUCTION x
.�", .,.,. 437.78
p�� SFR(2)bath
41d and 2-family dwelling ❑Commercial/industrial
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
JOB SITE.INFORMATION 'AND ()CATION` Site utilities:
Catch basin or area drain 18.76
Job site address: i ) L-}0 cU.) 1a
) � '00 eTr 4 Dr "L,_L,,
Drywell,leach line,or trench drain 18.76
City/State/ZIP: �'V Q4 0 p 1.7 2-2--.33 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: cia I lektik)CAAr Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Silligii . Rain drain connector 18.76
= Sanitary sewer(no.linear ft.: LLC 1 Page 2 (1/42 Ser
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
o-. Backwater valve 12.51
OES PIOI OWtI ;;
25.02
�# �: . '°� „ :' ,. r Clothes washer
/'-(-) ±-(-- 3-(til./.,e/K-
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,T4l z.0; Expansion tank 12.51
P P�R7 �, 1,...",,,. 4:.. '�" 25.02
�, Fixture/sewer cap
Name: �- Vi ,Jo 0,_(. (ja(,1./,z (,
` n , pFloor drain/floor sink/hub 25.02
Address: /.5 + q o J GAJ roi r4 r� IAA, Garbage disposal 25.02
City/State/ZIP: 7 2-2-3 Hose bib 25.02
Phone:('1) -0,( 2.Q Fax:( ) Ice maker 12.51
. Interceptor/grease trap 25.02
'/ g "< A PLIcAIN . . :,CO 1IA T PFRS9N�, .>.
Medical gas(value:$ ) Page 2
Business name:
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
Urinal 25.02
E-mail:
. . Water closet 25.02
" k. _. . f: CONTRACTOR r Water heater 37.52
Business name: I G(C k� p(--)c_ ___, U t'dc.;� Z/``4 1')p Water piping/DWV 56.29
l(p 7 JC? n
Address: �' � + `� �' (1+-e.,_„,(11_, Other: 25.02
City/State/ZIP: i . 0 ja,, f-7C)()`--) Subtotal 64.51,i
Minimum permit fee: $72.50 7�
Phone: J ) t I' - `?) __ Fax:( )
Plan review (25%of permit fee)
CCB Lic.: V 1((,9 I l Ol Plumbing Lic.no.: f3/A/55State surcharge(12%of permit fee)
Authorized signature: (T f',e..y1,7t- } () a (n 6` TOTAL PERMIT FEE
3.6
- \ t' This permit application expires if a permit is not obtained within 80 days
Print name: �• Va� 0�fR i 1 6 0(4*,\ Date: 3 i'21 1 p� 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`Ut l�h s '
Qty. Fee(ea) Total Shu-ire Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 3,601 to 7,200 $233.20
1 62.54 G A4. 7,201 and greater $327.54
Sewer-each additional 100' 37.52 1
Water Service-1st 100' 62.54
Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100'
Valuation:� Permit Fee:
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'' Qt3 ecrtea) s Total each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including$25,000.00.
$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*. � 4 �� wI
a Rv><ev ft> -PurringInstallati
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
pp y'
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
-Drive Thru as defined in OAR918 780 0040.
Cuspidor/Water Aspirator CIMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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"
Isometric or lser Diagrams
4
0 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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Reimbursement District Payment Worksheet
T 1 c;A R 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: 13 I Li 0 "31,0 H-0 '✓2 V� r
Reimbursement District#: 22 Parcel #: 2-5 103CA .
Amount Due: $ Amount Due Expires On: )-\ .ec..L 2NI--
Applicant: ,ictisw v. jeti°et- 661 11,41, Daytime Phone: (5141)1 rq—
❑ 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: $
❑ Deferral Agreement (signed prior to completion of worksheet)
IA
' By �-' — Date: 3 a-7 - �Gl5
BUILDING TO COMPLETE: `
Reimbursement Amount Paid: $ /�1 g Receipt #:
SWR #: PLM #:
Enter parcel conditions in Accela (check all that apply):
❑ Enter "paid" condition.
❑ Enter "deferral" condition,.;.
By: /f� �� Date: jfr-2(L
l
sei
Attach this worksheet to sewer permit for records scanning.
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_021014.docx
it-to sA)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
• 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.
ENGINEERING TO COMPLETE:
Site Address: j Si r{D S Noon r 1 r
Reimbursement District#: 01.. ( peek Parcel #: 5't o 3 C.A o o2 I %Z
Amount Due: $ 0' Amount Due Expires On: car
Applicant: ( akc:k Q k Daytime Phone:
0 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: Date: ///xe
BUILDING TO COMPLETE:
Reimbursement Amount Paid: $ 9' Receipt #: ,/ -
SWR#: (PA,J€o /100(' fa PLM#: jOGl h ,O l b=06l 3c
Enter parcel co tions in Accela (check all that apply):
❑ E "paid"condition.
Enter "deferral' condition,if applicable.
By: azei,,,..‘ree.„.
Date: '1/ti/iI
Attach this worksheet to sewer permit for records scanning
I:1Building\Riembursement Districts\ReimDistPaymentWorksheet_021014.docx