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Permit (38) CITY OF TIGARD PLUMBING PERMIT • 11-. COMMUNITY DEVELOPMENT Permit#: PLM2018-00205 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/01/2018 Parcel: 2S 103B D02000 Jurisdiction: Tigard Site address: 11835 SW CARMEN ST Project: Johnson Subdivision: CARMEN PARK Lot: 11 Project Description: 100 LF of sanitary sewer. Contractor: OWNER Owner: JOHNSON, DAVID W DAVID JOHNSON 11835 SW CARMEN ST 11835 SW CARMEN STREET TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-267-2607 PHONE: 503-267-2607 FAX: FEES Quantity Description Date Amount 100 If Sanitary Sewer 05/01/2018 $62.54 Specifics: 1 12%State Surcharge- 05/01/2018 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 05/01/2018 $9.96 Class of Work: ALT Plumbing 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 callin 503.232.1987 or 1.800.332.2344./4" Issued By: w ermiftee Signature:(4/4z(c, Call 503.639.4175 by 7:00 a.m.for the next available ins�paetibn 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 City of Tigard ^n t Received `'1 g i.^:. '' I t0 i� Date/By: S---- / /1 Permit No.lOLik 1�� p o!` 114 13125 SW Hall Blvd.,Tigard,OR 97223 °�/� (�/� C�C� I Plan Review ✓i I „ _ V a, Phone: 503.718.2439 Fax: 503.598.1960 f, - Date/By: Other Permit No.. /� T I G A R D Inspection Line: 503.639.4175 1 + ; r '1 Date Ready/By: km: 63 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information , ,, TYPE dF CORK t,, t f; FEE* SCHtU1.E - ' ,x;. ❑New construction 0 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) 1 We CCATEGORYDE CON 'I`I2.IJCTION SFR( )bath 312.70 Xf1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory buildingMulti-family SFR(3)bath 500.32 0 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION X Site utilities: Catch basin or area drain 18.76 Job site address: its`7 j 5 uj GRPew 5-1.- / Drywell,leach line,or trench drain 18.76 City/State/ZIP: ��o-'�� [ 0 t"/1 1 I 2-: Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name: S'�L✓6,,z Gc,'�A."-i-crsvR'' Manufactured home utilities 50.03 Cross street/directions to job site: & I Zis 4- y t Manholes 18.76 AP4/.AtOC-i Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ( ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: Cr 'Z44 6.l "ifiziz. I Lot no.: Il Fixture or item: Tax map/parcel no.: 2.5 i a 17.?;•Y. o.Z OC�0 Backflow preventer 31.27 ��y Backwater valve 12.51 DESCRIPTI i1 O6-4 - , "` ` " '" Clothes washer 25.02 CO(I'AT 1 ftOu5C �i'i i 1 56:4472 4,4A0 Dishwasher 25.02 bi 04 •?1-7-t--c.ypl) jf'P j - 114,11f`k Drinking fountain 25.02 Ejectors/sump 25.02 ' )P '/ t NER p TEf�i '- Expansion tank 12.51 Name: ti- u.) 5;K pt b0N Fixture/sewer cap 25.02 Address: ✓ Floor drain/floor sink/hub 25.02 5 Si r Garbage disposal 25.02 City/State/ZIP: . 1 4 5) OP-, '7 2.Z Hose bib 25.02 L. Phone:6©5) 24,7 -moo 7 Fax ( ) Ice maker 12.51 x'' 0APPLICANT ;.: ` :":❑ CONTACT PERSON 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 E-mail: Urinal 25.02 ,, 1 . ,,,,,,:v. Water closet 25.02 r. 'ItO CTOIt rt:s4; h.4 Water heater 37.52 Business name: oLtAl T I Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone:( ) Fax:( ) Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: r r> TOTAL PERMIT FEE Print name: Nil !G+ A712,2 This permit application expires if a permit is not obtained within 180 days Jv ' �� j�Y Date: y after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\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: �1 Utilities Fee(ea) Total Square Frage: Permit Fee-'4 Footing drain-151 100' 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 Storm&Rain Drain-1st 100' 62.54 Valuation: Perlinit Fee: $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 pie(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 Installa , Quantity by Fittdie Plan review is required for any of the following. Fixture Type for = Replace Please check all that apply. Work Performed: Capped Added Relocate + ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. ❑ New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic 0 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" OmetriC Or Rise 1 e:,,am 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 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 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 11111 Reimbursement District Payment Worksheet TI t;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: 11835 SW Carmen St. Reimbursement District#: 25 Parcel #: 2S103BD02000 Amount Due: $0.00 Amount Due Expires On: Dist. Expired Applicant: David Johnson Daytime Phone: 503-267-2607 Email Address: tand15150@yahoo.com n Sewer Loan Processed (journal entry to follow for payment of deferred sewer connection fee and reimbursement district fee,if applicable)* By: dtiltv•-•"- Date: 4/30/18 Name Printed: Jared Isaksen BUILDING DIVISION TO COMPLETE: *If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits. Reimbursement Amount Paid: $ Receipt #: SWR#: PLM #: Enter parcel conditions in Accela (check all that apply): O Enter"paid" condition. O Enter"deferral" condition, if applicable. By: Date: Name Printed: Attach this worksheet to issued sewer permit for records scanning. I:\Building\Riembursement Districts\ReimDistPaymentworlcsheet_NoDeferredAccounts 041918.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11835 SW CARMEN ST, TIGARD, OR, 97223 August 22, 2018 at 11 :29:38 AM Record Type: Record ID: Residential - Plumbing PLM2018-00205 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS - NoCofO Comments: Pump receipt received. Violation Summary: Inspector Contractor