Permit CITY OF TIGARD PLUMBING PERMIT
1r COMMUNITY DEVELOPMENT Permit#: PLM2013 -00173
Date Issued: 06/05/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S136DCO3506
Jurisdiction: Tigard
Site address: 7015 SW CLINTON ST
Project: Yoon Subdivision: ELNOLA HEIGHTS Lot: 16
Project Description: 130' sanitary sewer line for sewer connection in reimbursement district #46.
Contractor: WESTSIDE UNDERGROUND UTILITIES INC Owner. MOON, SUNG & HAE
10912 NW 309TH AVE 7015 SW CLINTON ST
NORTH PLAINS, OR 97133 TIGARD, OR 97223
PHONE:
PHONE: 503-447-1247
FAX: 503 - 681 -8045
FEES
Quantity Description Date Amount
130 If Sewer Service 06/05/2013 $100.06
Specifics: 1 12% State Surcharge - 06/05/2013 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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: R 744,4'
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.
1 .
Plumbing Permit Application
Building Fixtures
City of Tigard Received / / permit N
V 131 SW 13125 Blvd., Tigard,OR 97223 Date/By (!/ s �� �lao�3 — ao� 23
C Plan Review �� /3 BD
Phone: 503.718.2439 Fax: 503.598.1960 Date/By. Other Permit No.. � r a,
Inspection Line: 503.639.4175 Date Ready/By
T I G A R U ard or. ov '/ ® See Page 2 for
Internet: www.ti
g g Notified/Method. I Supplemental Information
TYPE OF WORK FEE" SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement lal Other:�n ri r1 D ewar New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION I SFR (I) bath 312.70
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25 02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: '7015 5 , (A) . 0,1i n-Eon Tf Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: (i/i' FCi i I ( C1-1 '' II -- V Footing drain (no. linear ft • ) Page 2
Suite/bldg. /apt. no.: `' Project name: 5 U n9 a tine 10U/'\ Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
X Sanitary sewer (no. linear ft /3O) Page 2
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
n Clothes washer 25.02
c (. r\ 1Q c.4-1',54. -to ` l � ` 1 ` Da.n l y � .)-U)Q/( Dishwasher 25 02
1 Drinking fountain 25.02
Ejectors /sump 25 02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: J n ci ti 1-10,e_ k.&(. Fixture/sewer cap 25 02
Floor drain/floor sink/hub 25.02
Address: 'l (' ( 5,w C (t yri0n ej'{ Garbage disposal 25.02
City/State /ZIP: i 1 914 (Di_ G(1 a, Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value. $ ) Page 2
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
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: U - t cig OnC2(9 r 6 0 1 , \ 0 U1 (rtI es, In( Water piping/DWV 56.29
Address: IN I L n u3 bocr'" aJQ . Other: 25.02
City/State/ZIP: L 3 Subtotal Me s e 6
ty � O ff�l � I �; n S I � � � f J /
Phone: („5;N3 ) L 11- i Fax: ( ) Minimum permit fee: $72.50
s � f b Plan review (25% of permit fee)
Q
CCB Lic.: (n� J' S 1 Plumbing Lic. no.: 3 jy- �f"� � State surcharge (12 % of permit fee) /2 , /
{(,t.
Authorized signature: V, �.''(' 10/1t�r" 7/f P / TOTAL PERMIT FEE //,2 4 7
Print name' This permit application expires if a permit is not obtained within 180 days
�� i e > � . Th v (Yn C} n • Date: 3 /3 after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I \Buildmg\Permiu\PLMU- PermitApp doc I0 /01/09 440.4616T(10/02/COM/WEB)
!\ .
Plumbing Permit Application - City of Tigard
: l Page 2 - Supplemental Information
Fee Schedule:
Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1" 100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain - each additional 100' 37.52 3,601 to 7,200 $233.20
Sewer - 1st 100' / 62.54 `2 7,201 and greater $327.54
Sewer - each additional 100' / 37 52 37.E
Water Service - 1st 100' 62 54 Medical Gas Systems:
Water Service - each additional 100' 37.52 Valuation: Permit Fee:
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
Q ty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Other Inspections or 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:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
I please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations
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 ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR9I8- 780 -0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor /Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher. - Commercial ❑ Any complex structure as defined in OAR918 -780 -0040.
- Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink. - 2"
3 „ Isometric or Riser Diagram
a" ❑ 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 Comments regarding fixture work:
Ice MachiRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar 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 plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
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ALOHA SANITARY SERVICE
INVOICE NO. zt
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 A 11451
503 -644 -2797 • 503 -648 -6254 • 503- 639 -5188
G��sTJ`ii). Gli�l0E.p y,d v t4 r
NAME: y � ,� i % i� S' , �.1/c
ADDRESS: /d7 /,% 4/ a). Ja7 P"---4- ,9Y!`r
CITY: /0491 -% ? ,/jyi,P./ Y STATE: Q ZIP: 77,..7,...?
HOME: j 1 hic2,0/-?-no / 73 WORK:. >. "" r7;, : :; CELL: 7‘, X40 9/
MOB SITE: 7a r l
., S, �. GL i 'e/T� f 77 7 i� P.O. #:
PAID BY CHA CHECK ❑ CASH ❑ CREDIT CARD ❑
DATE - 7 /l - -- DRIVER f // -- 74aaa Tioaf AMOUNT
PUMP SEPTIC TANK Lf Q _'_
❑ LINE OPENING
❑ INSPECTION FEE -
❑ SERVICE CALL
❑ LABOROCATING, DIGGING, BACKFILL
Cl. _ MATERIAL
, f / ,1f
- - THIS Is NOT A SEPTIC SYSTEM INSPECTION REPORT - -
I TOTAL $,445 ?
- - REMARKS - -
TYPE OF TANK: STEEL ❑ CONCRETE ❑ PLASTIC ❑ HOMEMADE
HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ❑ ETFf R
SIZE OF TANK: 350 ❑ 500 ❑ 750 ❑ 1000 0 ❑ 1500 ❑ 2000 ❑ 3000 ❑
LID LOCATION: INLET ❑ OUTLET ❑ IDDLE ❑ ENTIRE TOP ❑
TANK CONDITION: GOOD ❑ AsR POOR ❑
FITTINGS: BAFFLE �/ CONCRETE ❑ CAST IRON ❑ PLASTIC ❑
NEEDS NEW LID? SE U SIZE '
GROUND COVER OVER TANK
COMMENTS ON CONDITION OF DRAINFIELD ETC.
SIGNED BY DATE
t — — -1 4, -
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