Permit (26) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018 00255
Tr GAP D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/30/2018
Parcel: 2S 103 D D00406
Jurisdiction: Tigard
Site address: 10815 SW FAIRHAVEN ST
Project: STUART Subdivision: FAIRHAVEN COURT Lot: 2
Project Description: 75 ft.of sanitary sewer to connect existing house to sewer.
Contractor: SIERRA CONSTRUCTION&EXCAVATION LLC Owner: STUART, NATHAN&EMILY
PO BOX 30642 10815 SW FAIRHAVEN ST
PORTLAND, OR 97294 TIGARD, OR 97223
PHONE: 503-492-9242 PHONE:
FAX: 503-252-9808
FEES
Quantity Description Date Amount
75 If Sanitary Sewer 05/30/2018 $62.54
Specifics: 1 12%State Surcharge- 05/30/2018 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 05/30/2018 $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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /' 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.
Plumbin i • - ' . p 1 lication
Building I..) \ FOR OFFICE USE ONLN
City Mgri8a0d2 018 c.ii-i. , ,, Received
Date/By: 57,?OfiiPs- Permit No.:paillAcyroOR 53--
. 11 13.1, 5§y Hall Blvd.,Tigard,OR
I PIUirt 0,503.598.190Q
IN
Plan Review
M
Date/By: Other Permit No.a440 i -< 6///
T I G A R D Ettat'ir I.'....Oil Arlj r 14 1\1\
,,. Date Ready/By: Juris: iZi See Page 2 for
r‘ l'o'i„. otified/Method: Supplemental Information
TYPE OF WO ,. (3 01\1151. ' "''' '''' ''''"' ' FEE* SCREDULE
4,- ' , , ,,,,- • i v information
. ;-
0 New construction 14 0-molition For special use checklist
connection)
Addition/alteration/replacement
D Other: New 1-2-family dwellings
'54f ,.CATEG64E OP cONSTItileTION ,;', ' Description Qty. Ea. I Total
(includes 100 ft.for each utility
SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
D Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
SOB SFFE INFORMATION AND LOCATION2f ,. Site utilities:
Job site address: 3&A./--Fp../4.1/4-v-50 -r Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7.-feske /ce_ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:51744v,...fr
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: 25 / Page 2 61).
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
-1dupiloWiiiicworui„,, '.•;';„,:, ,u,d, 4M1: ,::, Backwater valve 12.51
„„• - • 1 ', - 1 5'- ''',\•- ',-0',.' ,s' Clothes washer 25.02
)45-rgliaN6 Siliving-lo(J--Emir74. Li-iev Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Ex
• 0'PROPERTY OWNER , , '. 1 0 TENANT-- -: Expansion tank., , P 12.51
Fixture/sewer cap 25.02
Name: A)4471 1# t--....(v),/ ,JAurve.9--
, 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
0 qp4c,. T-e,:::17, IN, ' 0oNT4CT pERso,, Interceptor/grease trap 25.02
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: i
crifilaric4144.,-Tro v.. ..Clitt,,fi 1_co 4/1
,.____ ,... __'• Water closet 25.02
CONTRACTOR
_ - - Water heater 37.52
Business name:52.X.444. 4 -->t(4,04.71 orii (97'l.sfr.
Water piping/DWV 56.29
Address: p.s,3,mc -306,(1,--, Other: 25.02
../..-
City/State,ZIP: ,p-i-LD or,_, C1 72 Subtotal (i),..57-1
Phone:(503) fico )L2 Fax:(5(1 ) 050- 'ie,CA6 Minimum permit fee: $72.50 )0/.. ')
Plan review (25%of permit fee)
CCB Lic.: ilot/ el - Plumbi ic.no.: 4}1 -27X/S
State surcharge(12%of permit fee) r, 7-0
....._.
Authorized signaturA. \ 5-Ye-dCi? TOTAL PERMIT FEE i 1 Jo
This permit application expires if a permit is not obtained within 180 days
Print name: Date:
after it has been accepted as complete.
.5-‘9 5g9-al ire‘i *Fee methodology set by Tri-County Building Industry Service Board.
1 ABuilding\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 • Qt ,_ Fee(ea) Total _ =Square ootage: erfl tFeet
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
3,601 to 7,200 $233.20
Sewer-1st 100' ` 62.54 /')
6,,,z-311 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 ee:
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
. - Fee a each additional$100.00 or fraction thereof,to
Other Inspectionsaor Fees ) _ 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal: / 67
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*. > n*cv1 W f r Plumbing;,Inst llad ns 2":"
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
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial al
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" �,_:
3" us w �sometrk orTiser Magr in
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice MachlRefrig.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_PermitApp.doc 08/04/2011 2
HE EI VED
MAY 3 0 2018
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ��t Ut- I IGARD
• 11 .D4\iG oivisi '
Reimbursement District Payment Worksheet
TI G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
This worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbing permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the Building Division.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: 10815 SW Fairhaven Street
Reimbursement District#: N/A Parcel#: 2S103DD00406
Amount Due: $0.00 Amount Due Expires On:
Applicant: Emily& Nathan Stuart Daytime Phone: 503-250-3736
Email Address:
Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee, if applicable)*
By:
Date: 5/30/18
Name
Printed: Jared Isaksen L
BUILDING DIVISION TO COMPLETE:
*If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ Receipt#:
SWR#: aO i$— 0G)®1-frj PLM #: "447 %t= cx>153
Enter parcel conditions in ela (check all that apply):
Enter " i condition. NO-
nter "deferral" condition,if applicable.
By: �r`1�1i✓ ti' 11/04171—. Date: ,j/jWit''
Name
Printed: � � /9—
Attach this worksheet to issued sewer permit for records scanning.
1:\Building\Riembursement Districts\ReimDistPaymentWorksheet NoDeferredAccounts 041918.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10815 SW FAIRHAVEN ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2018-00255
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Septic tank pump and backfill- approved
Violation Summary:
Inspector Contractor