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Permit (182) CITY OF TIGARD PLUMBING PERMIT • 7li ' COMMUNITY DEVELOPMENT Permit#: PLM2018-00316 T E GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/28/2018 Parcel: 2S103BB10000 Jurisdiction: Tigard Site address: 12060 SW 122ND CT Project: PALACIOS Subdivision: YE-OLDE WINDMILL Lot: 21 Project Description: Replacing(5)ft.of sanitary sewer. Contractor: PACIFIC GENERAL CONSTRUCTION LLC Owner: PALACIOS, RUBEN&OLGA PO BOX 220179 12060 SW 122ND CT MILWAUKIE, OR 97267 TIGARD, OR 97223 PHONE: 503-490-7727 PHONE: FAX: FEES Quantity Description Date Amount 5 If Sanitary Sewer 06/28/2018 $62.54 Specifics: 1 12%State Surcharge- 06/28/2018 $8.70 Plumbing 10 ea Minimum Fee Adjustment- 06/28/2018 $9.96 Type of Use: SF 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 1.800.33 . �--� C. Issued By: Permittee Signature: .... --.7411.r‘ ."6: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 i v iv-pi City of Tigard ,L4, y, "'"i '" Received /,,, e ` Date/By: W J X eb - Permit No.: ddi M�7�/if, �y�3`6 Ilig 13125 SW Hall Blvd.,Tigard,OR 97223 /rY rQ`f,./ W Plan Review I Phone: 503.718.2439 Fax: 503.598.19603 uDate/By: Other Permit No.: 1 l G A R D Inspection Line: 503.639.4175 �� Ready/By: Juris: H See Page 2 for Internet: www.ti and or. ov Date g g y a -^ • Notified/Method: Supplemental Information TYPE OF WORI r FEE*SCHEDULE 0 New construction k $ T r I V I SION For special information use checklist ���...+++ Description I Qty. I Ea. Total Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORr QF'.CONSTRUCTION SFR(1)bath 312.70 ,izr1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 building - SFR(3)bath 500.32 ❑Accessory 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: / v 0 k) I AOC 1. Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 1 City/State/ZIP: - C' C• J/ { L )? 9 <i'7(a.9:2 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:5'...) 1 Page 2 6,,Z.,57t 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 O 3W©RK qtr, xy Backwater valve 12.51 g } r / y Cisthes washer 25.02 Cr/� & �.�.�� 1 0 ��' Dishwasher 25.02 `� P0,2 -ifd �f y c g o t ./ &)74R5 Drinking fountain 25.02 V / F Ejectors/sump 25.02 ❑ PROPERTY OWNER I 0 TENA 1)[ 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 APPLICANT „ '; ❑ CONTACT PER'SI'3N Interceptor/grease trap 25.02 c Medical gas(value:$ ) Page 2 Business name: (�L, 1c )T����� Primer 12.51 Contact name: -3-0t C. /`- n a,-),,)cl_e_2 - Roof drain(commercial) 12.51 Address: f 0 Dc'K2 Sink/basin/lavatory 25.02 City/State/ZIP: 01 : /�,jo Q� 9 7 Solar units(potable water) 62.54 Phone: C ) r)9 ) , 7 77 7 Fax: :(. ) `�7 3 , , Tub/shower/shower pan 12.51 r /pia., Urinal 25.02 E-mail: f C. LLL j ie 1�✓a'11 i'C60y9V / Water closet 25.02 CONTRA OR / Water heater 37.52 15 Business name: C L-1.,C Water piping/DWV 56.29 Address: Foleox 2 20 / 7, Other: 25.02 City/State/ZIP: /27� 1 1 . ,0. v A <,y 0 7'2 6 C Subtotal Ga Phone:(7) 90 , 72,2_ 7 Fax:(,..7., 7,2„3, ` Minimum permit fee: $72.50 r), CCB Lic.: 0 Plumbing Lic.no.: , <170 Plan review (25%of permit fee) !lie State surcharge(12%of permit fee) if,7 Authorized signatur-• _ p p TOTAL PERMIT FEE (_ Print name:; r f A-A-y-1e- Ley Date:4,.a0,-/a This permit application expires if a permit is not obtained within 180 days V 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 Utilities Fee(en) Total [ a e Footage Permit Fee My Footing drain-1S1 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' % 62.54 3,601 to 7,200 $233.20 S� 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:. PerMit Fe0: f' $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 (jty.` 'li+ ,(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or, t 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*. Plaf� ew for . gibing II11StA I is 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 Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thias 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 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" Isometric or Riser ><. 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 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12060 SW 122ND CT, TIGARD, OR, 97223 Record Type: Record ID: Residential - Plumbing PLM2018-00316 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor