Permit (149) CITY OF TIGARD PLUMBING PERMIT
$11 - COMMUNITY DEVELOPMENT
Permit#: PLM2018-00557
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/10/2018
T l i ;l I'.t g Parcel: 2S111 BD00700
Jurisdiction: Tigard
Site address: 14980 SW 96TH AVE
Project: Palmer Subdivision: DARMEL NO.2 Lot: 16
Project Description: Connect existing residence to public sewer. Septic system to be pumped/filled or removed and receipt provided
prior to final inspection.
Contractor: SHERWOOD PLUMBING COMPANY Owner: PALMER FAMILY TRUST
22718 SW MARTIN CT BY MILLER,JAN MARIE TR
SHERWOOD, OR 97140 22905 SW MOUNTAIN HOME RD
SHERWOOD, OR 97140
PHONE: 503-349-5429 PHONE:
FAX:
FEES
Quantity Description Date Amount
50 If Sanitary Sewer 12/10/2018 $62.54
Specifics: 1 12%State Surcharge- 12/10/2018 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 12/10/2018 $9.96
Plumbing
Class of Work: OTR
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: Q /
Call 503.639.4175 by 7:00 a.m.for the next available ins.-ction 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 Applicat4t
ECEIVED
Building Fixtures FOR OFFICE I_S1 ()NEI
DEC 1 0 2018
City of Tigard Received
Date/By: 40.-//Or" .0444.------ Permit No/Ck irti2re.-I:VS:577
it 13125 SW Hall Blvd.,Tigard,OR on OF TIGARD ig Plan Review
I Phone: 503.718.2439 Fax: 503. .
Date/By:te/By: Other Permit NI......cy2,241/t-4,6277
TI GA R I)
Inspection Line: 503.639.4175 rIUILDING DIVISION
Date Ready/By: Juris: gi See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK iliy ,. FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
_ /Description I Qty. Ea. Total
, Addition/alteration/replacement 00ther: s -4t- ,(02_. ecidA7g-a-IcAl New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF c4;) 1' .' opt ' .t- SFR(1)bath 312.70
pl-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB .,t sr INFORMATIO AND LOCATION,fv•1'' Site utilities:
Job site address: / 14Fef-e? .Sixi% 94 4-4---- /1-1/46" Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
AJ
LcSanitary sewer(no.linear ft.:cD)) Page 2
0 -/ti/ -eliel-s.e7y E .v7-- 2S/s779--(er.9,0 - . 2 7
toter service(no.rm sewer(no.linear ft.:_) Page 2
4. 7/. 4'i 2C. ce-r- /) ... "74/ ."Vtie i ..7184f-
linearaft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
Backwater valve 12.51
OF C.,.'' , '.....';',,,Wk ii'
Clothes washer 25.02
e0A7A/ C 7 '-'3ef--C.771•/6: Afe ti-C67 77) d°a6 4-'C'Dishwasher 25.02
_5-64/En- •-• /C)a // ./Z_Z_, scri7 c_. ' Drinking fountain 25.02
/21-1//AC- ,e....6---e, 7,07 , Ejectors/sump 25.02
4pRopiiciivikiE17 :1-; 1 'z.,.4- :1;7 p:,,,C ''.,7 'ill; Expansion tank 12.51
t'v ' - I , ?ec:: -!",;.4A..d.,,,,,,, ,. ,
Fixture/sewer cap 25.02
Name: Tot t LAAeAr- .(A.VIA..- k3* 1--(-LIL4.---- Floor drain/floor sink/hub 25.02
Address: ;22q 6,5 i,t.) ,,,,,f.k, /4 „„,. ,-,p,..,„,
Garbage disposal 25.02
City/State/ZIP: ski/1,, ,,ed o 9 7,' /i.2 Hose bib 25.02
Phone:(34 5) 70 crig 5 Fax:( ) Ice maker 12.51
o April, :,,,i, ' :::i.:, cificoNTAci, PERSON ;i, 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:
'.,:•-,7 ''''t,„ '5''',' *,:. 7r R ,,,:/ .11:Aa..,,,, Water closet 25.02
CONTRMFTO
Water heater 37.52
Business name: _5/0yE.../4.Ai a azs /04it 17 6/A/6-- Water piping/DWV 56.29
Address: ,, -2,,p .5k) /-7/9-72._7".Je -r Other: 25.02
City/State/ZIP: ,S ' 72&ii 0,t.. eg- 9.2/ l-.40 Subtotal
/ Minimumpermit fee: $72.50
Phone:(..5.0,,:1)3 '9 - '/L9Fax:( )
Plan review (25%of permit fee)
CCB Lic.: ..>2i 0 cps/ Plumbing Lic.n49/3,7
State surcharge(12%of permit fee) g. 70
Authorized signature: filar le H ki I to r--- TOTAL PERMIT FEE ff 4
Print name: Date://71 ,i6.,..; ..-
/ This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Buildtng\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. Fe4(ea) Total Square. ''dotage: Permit Fee: ,
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
Sewer3,601 to 7,200 $233.20
-1st 100' 62.54
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gast Systems:
Water Service-each additional 100' 37.52
vhiva�on: T Permit Fe+ ry `Y
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
Other Initiections Or Fees, 90., , fee(es) 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*. n Review �� , " mbing
atlon �
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Ria Please check all that apply.
Work Performed: Capped, Added Retocpte
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
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic ❑ 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" e
• � • 1 1
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
■ Reimbursement District Payment Worksheet
T I(,;\It t) 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: 14980 SW 96th Ave.,Tigard, OR
Reimbursement District#: 27 Parcel #:
Amount Due: $14,671.61 Amount Due Expires On: 3/8/2019
Applicant: • ./ /'1 t 1 6 R. Daytime Phone: 7i '/ „3 9
Email Address:
ID Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee,if applicable)*
By: Maw Qua.di Date: 12/3/18
Name
Printed: Mai Quach
BUILDING DIVISION TO COMPLETE:
If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ /y 67/. ri/ Receipt #:
SWR#: ,2O/P'00,277 PLM #: o?Q/f—'OS" 7
Enter parcel conditions in Accela (check all that apply):
.
..s Enter "paid" condition.
El Enter "deferral" condition,if applicable.
By:
Date: %02`�d/.14-'
Name
Printed: `)5/<f/vicii." /7/2,7641-
Attach
'.fAttach this worksheet to issued sewer permit for records scanning.
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDeferredAccounts_041918.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14980 SW 96TH AVE, TIGARD, OR, 97224 January 14, 2019 at
7:30:03 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00557
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Pump receipt received
Violation Summary:
Inspector Contractor