Permit (52) CITY OF TIGARD PLUMBING PERMIT
INT-I COMMUNITY DEVELOPMENT Permit#: PLM2019-00115
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/21/2019
[ t i; I`Dg Parcel: 2S111AB05900
Jurisdiction: Tigard
Site address: 14370 SW 93RD AVE
Project: OGDEN Subdivision: PENROSE TERRACE Lot: 4
Project Description: Replacing 70 ft of sanitary sewer.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: OGDEN, CRAIGE J&RAFEEQAH D
267 NE 34TH PLACE 14370 SW 93RD AVE
HILLSBORO, OR 97124 TIGARD, OR 97224
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
70 If Sanitary Sewer 03/21/2019 $62.54
Specifics: 1 12%State Surcharge- 03/21/2019 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 03/21/2019 $9.96
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 .800.332.2344.
Issued By: *AO/ / /ioe, Permittee Signature:
/7(Z‘....
Iii, ____....) ›.....
Call 503.639.4175 by 7:00 a.m.for the next availableinspection 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
,„,., ,_ „,_ ..,,,,
Site Utilities 11- , , ' '
„.. . , ., ,. FOB OFFICE I SE ONE\
City of Tigard Received
MAR 2 1 2019 Date/By: ,c A( ) i )//5
faell9i)a,--co//5----
,114 11 13125 SW Hall Blvd.,Tigard,OR 97223
, 111 Phone: 503.718.2439 Fax: 503.598.1960 -, Nan Review
- ,,-‘ Datc/By: Other Permit No.:
Inspection Line: 503.639.4175
TIOA.RI.-` L L i ' , ,,,: L-;'v: --, 3f;,pate Ready'By: Jurist 0 See Page 2 for
Internet: www.tigard-or.gov '- Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description L Qty. i Ea. Total
)S1 .4dditionJalteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
IN)-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath , 500.32
El Accessory building El Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: ‘45-1 C) SU,) 13 ra lAviz,- Drywell.leach line,or trench drain 18.76
City/State/ZIT/1..1 OcA 0 f-,
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.: b)'i1 Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
r---- _
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
1:)\f•C.c.,‘\°wok\ J \\ rde-sr\a, 'ATAt'1/43 Si....x.,Ote- Dishwasher /5.02
[-M . \?\_eiNiv\e- 0 1(1/$0:iits Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: 641„ Fixture/sewer cap 25.02
,..,
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal /5.01
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease/rap 25.02
Business name: Medical gas(value:$ ) 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
rinal 25.02
.
U
E-nlail's14C19_ Cockoviat 5iroqv a.(Au-.
Water closet , 25.02
CONTRACTOR
.. r., -\--- el Water heater 37.52
Business name: -6\\ø .j1 . ti,,,ae.. . v..4,1a,cor 0.-ek, Water pipingiDWV 56.29
Address: 'ali tjc. 3(4k\,,, st) Other: 25.02
City/State/ZIP: WA‘s\De to 0 j1) Subtotal
Minimum permit fee: $72.50
Phone:(56 ) SZ g 4 101 0 Fax:( )
Plan review (25%of permit fee)
CCB Lie.: \1;\ co \\Co\ I Plumbing Lie,no.: p? 11455
State surcharge(12%of permit fee)
Authorized signatur ......7.9.--, ,......>
#.. TOTAL PERMIT FEE
'
This penult applicatkin expires if a permit is not obtained within 180 days
Print name: pc,c,k) im eV e.i ' Date: 3 121 )z,,11
after it has been accepted as complete.
*Fee methodology set by Tri-County Buildinu Industry Service Board.
I:ZtulatagPernuts,PIAlli-PernutAno.doc 10,01 00 440-4616T(10 02,COM WEBi
Plumbing,Permit Application City of Tigard
1age 2 Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Qty. Fee(ea) Total
Site Utilities Square Footage: Permit Fee:
Footing drain-l'`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:
51.00 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 qty' Fee(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) l _ _ _ and includin $25,000.00.
Inspections outside of normal business 90.00/hr 525,001.00 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required d for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial . 0 Medical gas and vacuum systems for healthcare facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
3"
4" Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food LI Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice`Mach.Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter ,y
Washer-Clothes Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDLIs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\Drew\Desktop\Black Rock Underground\2019 Documents\PLMILPermitApp.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14370 SW 93RD AVE, TIGARD, OR, 97224 April 10, 2019 at 8:36:04 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00115
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor