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Permit (61) CITY OF TIGARD PLUMBING PERMIT : . . ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00237 T-I 6 A R 0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/10/2019 Parcel: 2S103ACO2900 Jurisdiction: Tigard Site address: 12465 SW 112TH AVE Project: Saling Subdivision: MCMICHAEL HEIGHTS Lot: 7 Project Description: 100 LF of sanitary sewer. Contractor: CURTIS HEINTZ EXCAVATING INC Owner: SALING,WALTER ALLEN PO BOX 1105 12465 SW 112TH AVE SHERWOOD, OR 97140 TIGARD, OR 97224 PHONE: 503-519-3936 PHONE: 503-925-9400 FAX: 503-925-8014 FEES Quantity Description Date Amount 100 If Sanitary Sewer 06/10/2019 $62.54 Specifics: 1 12%State Surcharge- 06/10/2019 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 06/10/2019 $9.96 Plumbing Class of Work: NEW 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. / n t Issued By: //I ,�'r Permittee Signature: _.„.40.‘( 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 projec Approved plane aro required nn tha jnh cite of the times of aarh incpertinn Plumbing Permit Application Building Fixtures City of Tigard ! a ReceivedBy / /� //i /jif P q 13125 SW Hall Blvd.,Tigard,OR 97223 i ' ` W PlaDan Review(�(/ (�6/ /fjQ'- l/ �� Plan 1111 ■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: G/ -2/ Inspection Line: 503.639.4175 `pte Ready/By: Juris: la See Page 2 for T I G A R D 12u,, Internet: www.tigard-or.gov Nbtified/Method: Supplemental Information .-,;. sem:. ";:-. S t "` ❑New construction 0 Demolition For special information use checklist. Description I Qty. I Ea. I Total at Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) ' ., - CATEGORY OF CONSTRUCTION s SFR(1)bath 312.70 o 1-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 INFORMATION LOCATIONSite utilities: Job site address: 4;31/(h 5j 3 to `(xik(4-veno p Catch basin or area drain 18.76 i Drywell,leach line,or trench drain 18.76 City/State/ZIP: 77J y'c,.,1 ©RECOAi 9 74R.) Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: JO a 1,,,,, f• 5 v rp Q f Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.//O)) Page 2 (2 r_5y 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 �° 4. Backwater valve 12.51 o ' 1 ION OF., ,ham i, �F- n " v . . . ..,. .'" ...,. " , Clothes washer 25.02 ( (o f 11�6 7�l d� €/-15 �e��/C- Dishwasher 25.02 l `-Y Y l C.I(3k Qct' ' S e-O e V Drinking fountain 25.02 Ejectors/sump 25.02 2,13;;;.:Cit" . 'ti pW)~IER 0 TEN Expansion tank 12.51 Name: earl^ Fixture/sewercap 25.02 S � � Floor drain/floor sink/hub 25.02 Address: fes' � A r ewe e Q��>�� �L Garbage disposal 25.02 City/State/ZIP: / / (,t / Q R 9 7 ,�3 Hose bib 25.02 Phone:(5 3) 3 / Fax ( '._) -� Ice maker 12.51 �.. ❑ SSSS 2 p �� `.�, t � 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 Water heater 37.52 c7fIritA Business name: C Ul V >' t L-^ L V ( � Water piping/DWV 56.29 Address: A1100 6 ' C21(.eb{t\ 5Yl,�d' Other: 25.02 City/State/ZIP: 6 he jW L)0c1 i 0 I Subtotal Phone:( ((3 9 5- . 9'/ b Fax:( ) 7/'/bo Minimum permit fee: $72.50 CCB Lic.: o 3 14/s > Plumbing Lic.no.: poi,-160e/li`60e/ Plan review (25%of permit fee) - State surcharge(12%of permit fee) Authorized signature: C / ( TOTAL PERMIT FEE Print name: W� J/7t I h Date:In-IV I This permit application expires if a permit is not obtained within 180 days \y ' ) ttf fii after it has been accepted as complete. 'Fee mahodt&gy At bf T.;Ce....tt Da;IJ:ng I..t..s6y 6„rvi..o D..ard. 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. Fee(ea) 4Q,w notal Square Footage: Fernut Fee: Footing drain-15'100' 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 aluation: 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 OtlSpeCti0II8 or Fees QlY';' �(ea) T 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*. trAian Review for Plu 1:1r5;,. a OuAlititrWirixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performeth Cates Relocate 0 Any new commercial building with water service 2"and Baptistry/Font Bath Tub/Shower greater,except systems designed and stamped by licensed -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure Drive tallThras 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 El 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" �irgas e r -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 plumbing Closet-Toilet P g 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 1it,,1.t?.r 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: 12465 SW 112th Avenue Reimbursement District #: N/A Parcel #: Amount Due: $0.00 Amount Due Expires On: N/A Applicant: Walt Saling Daytime Phone: 503-519-3936 Email Address: SalingW@trimet.org ❑ Sewer Loan Processed (journal entry to follow for payment of deferred sewer connection fee and reimbursement district fee, if applicable)* By: ,„/Auj Date: 6/20/18 Name Printed: Jared Isaksen BUILDING DIVISION TO COMPLETE: *If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits. Reimbursement Amount Paid: $ Receipt #: SWR #: PLM #: Enter parcel conditions in Accela (check all that apply): 111 Enter "paid" condition. 0 Enter "deferral" condition, if applicable. By: Date: Name Printed: Attach this worksheet to issued sewer permit for records scanning. I:�B.tt f..g�R,t...6..J�.d ..1Mnl. uaudWvx acct NuDcf6ncdAcwunts 041918 docx