Permit (61) CITY OF TIGARD PLUMBING PERMIT
' I COMMUNITY DEVELOPMENT Permit#: PLM2019-00269
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/02/2019
T f t ;�R[� g Parcel: 2S102BA01900
Jurisdiction: Tigard
Site address: 9885 SW JOHNSON ST
Project: LANDWEHR Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 20
Project Description: Replacing 90 LF of sanitary sewer.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: LANDWEHR, LUKE&JENNIFER
267 NE 34TH PLACE 9885 SW JOHNSON ST
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-747-9312 PHONE.
FAX: 503-214-5886
FEES
Quantity Description Date Amount
90 If Sanitary Sewer 07/02/2019 $62.54
Specifics: 1 12%State Surcharge- 07/02/2019 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 07/02/2019 $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, Stat- • OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will e •'e if ork is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires ou to ff low the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 95 -001-0090 You may obtain a opy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332. 344.
Issued By: t� Permittee Signet '411411111111.
' 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 • • oject.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
Received r� / l�`!/'r/G „.....e.02(04,„.....e.02(04,„.....e.02(04,City of Tigard Py�
Date/By: /
13125 SW Hall Blvd.,Tigard,OR 9722 L C n
111 Phone: 503.718.2439 Fax: 503.598.19 0 =` ^f-• ' Plan Review Date/By: Other Permit No.:
T 1 C A It D Inspection Line: 503 639.4175 (; Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov BI.JiL t„ i Ll ,i'--,:,ki Notified/Method: Supplemental Information.
❑New construction 0 Demolition For special information use checklist.
Description Qty. Ea. I Total
ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
D1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
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 INkQRMATION AND, LOCATION.;. Site utilities:
Job site address: 6\ S O " ' a Y1SaY1 S'\7• Catch basin or area drain 18.76
` Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1 6 0 .1. Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: S 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.:lb ) 1 Page 2
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
„fl; .'. off, woltle'? Backwater valve 12.51
Clothes washer 25.02
�e. by 1"sit 1 Pe_ �o►c_Q,, S,A\rt.�dvc%) Dishwasher 25.02
S ,C \4A e-�t 4'\ E'•I-cc,c MNP.,`r 4N14C, )1 0 il1,Q Drinking fountain 25.02
\r Ejectors/sump 25.02
' OPERTY OWNER, �. `,- - x ti y.i� Expansion tank 12.51
-- �l" V G/ ��� Fixture/sewer cap 25.02
Name: -07'141,1/.6V //I l�tt -
Floor drain/floor sink/hub 25.02
Address: bF' .Cc- Sh; szvi lac.
ALJ Garbage disposal 25.02
City/State/ZIP: J) K-( art--- 7 20.J r Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
,!. `Y SACTF '6, Interceptor/grease trap 25.02
Business name: �j Medical gas(value:$ ) Page 2
`� ir�fV� �� �1,.��J",�� 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
_rD q, AL1 amu\, Vr Urinal 25.02
t
E-mail: l I: 'F drek•(`p01f1 A.
r!1 � -r�-V -
Water closet 25.02
'j .... y `,.r 7 iii crit :, , Water heater 37.52
Business name: Qi6k.CAC.. U o JrTA
LL(, Water piping/DWV 56.29
Address: 71\131.4\sN 0) Other: 25.02
City/State/ZIP: >»sb•so $ aI Z L.1 Subtotal
Phone:(in) D Z D )1,...t1 ! Co Fax:( 1 ) Minimum permit fee: $72.50
CCB Lic.: \ 6%(O \ \0 Plumbing Lic.no.: f ib`Li%r - Plan review (25%of permit fee)
- ,, A 1 State surcharge(12%of permit fee)
Authorized signature: /t.:p.( 4C TOTAL PERMIT FEE
Print name: /`n Date: 12, 0>i<1.1This permit application expires if a permit is not obtained within 180 days
��`_J'\ after it has been accepted as complete.
*Fee methodology set by Th-County Building Industry Service Board.
I 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 Qty. a(ea) Total Square Footage: Perml eC:
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' Permit Fee: ,d
$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
.t r Inspections or Fees Qty' Pe 01) 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
k
accurately report fixtures could result in increased sewer fees*. > Plan't',.view a °°mo 1*h* .11(0V.,
Quantity by lure Ty* Plan review is required for any of the following.
Fixtutit Thiefor. Miguel w Please check all that apply.
w° �t"rCaPPed Aed 0 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.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
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"
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
Tel: 503.718.2439
Location: Inspection Date:
9885 SW JOHNSON ST, TIGARD, OR, 97223 July 11 , 2019 at 2:19:47 PM
Record Type: Record ID:
Residential - Plumbing PLM2019-00269
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor