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Permit (2) CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2019-00391 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2019 T l C'A R.D g Parcel: 25111 BB01000 Jurisdiction: Tigard Site address: 14300 SW 103RD AVE Project: Johnson Subdivision: TIGARDVILLE HEIGHTS Lot: 16 Project Description: Install 75 feet of sanitary sewer line for sewer connection for existing residence. Septic system to be pumped and filled or removed. Pump/fill receipt required at final inspection. Contractor: KERR CONTRACTORS OREGON INC Owner: JOHNSON, MARY R PO BOX 1060 14300 SW 103RD AVE WOODBURN, OR 97071 TIGARD, OR 97224 PHONE: 971-216-0050 PHONE: FAX: FEES Quantity Description Date Amount 75 If Sanitary Sewer 10/02/2019 $62.54 Specifics: 1 12%State Surcharge- 10/02/2019 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 10/02/2019 $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 (ling 503.232.1987 or 1.800.3 .2344. Issued By: Permittee Signature: 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. I PIunTbing Permit Application _ Site Utilities "' V FOR OFFICE USE ONLY Received City of Tigard /0//ii, Permit N LMA"/9_ao39/ Illi vateB 13125 SW Hall Blvd.,Tigard,OR 97223 OCTC I 1 2��9 y Plan Review 0; Phone: 503.718.2439 Fax: 503.598.1414.1,, t,,, Date/By: Other Permit N9-4J� �9-4 4P TIGARD Inspection Line: 503.639.4175 C� OXY I A7/Pt l Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov 721 = .°Ir'' Notified/Method: SupplementalInformation TiPE OF WORK FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description Qty. Ea. Total Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) / CATEGORY OlpCONSTRUCTION SFR(1)bath 312.70 [x1-and 2-family g dwellin SFR(2)bath 437.78 ❑ Commercial/industrial ❑Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORNIATION AND LOCATION Site utilities: Job site address: 7y340 51„, /U. 12_1) 4✓e Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: '/(rm/Z 0 O/ f7 Z Z L( / Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: //z/K/4 c7-- Manufactured home utilities 50.03 Cross��sttrrreet/directions to job site: Manholes 18.76 ,e,i-b r Si 131:-= ©/- /d 3 IZ 6./u)-1: . Rain drain connector 18.76 1-�•�/�O� c Sanitary sewer(no.linear ft.:7r) 7S-- Page 2 (e 2 yam/ /S ,s-,u ,44t v✓ ft/f31�.W Srr•J Storm sewer(no.linear ft.: ) Page 2 /4'f2-E a' Water service(no.linear ft.: ) Page 2 Subdivision: J2 K✓+ Cr-. Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK ` Backwater valve 12.51 CuClothes washer 25.02 s 74-A..//y`/i01-e._/- S/ W//Z PuN.6-C.TiOr✓ Dishwasher 25.02 / Drinking fountain 25.02 Ejectors/sump 25.02 iki PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51 Name: g,v G ) T01410 SO Fixture/sewer cap 25.02 / Floor drain/floor sink/hub 25.02 Address: /y 3 DO .5 W /0 s le IN /4t/I." Garbage disposal 25.02 City/State/ZIP: Y7 6,-,91-4 4Iz I� / a I Z 9 7152-4-/ Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Ae7Z� �wrizetc._�Q 1Z y df? (�-Owl Ham, Medical gas(value:$ ) Page 2 h v Primer 12.51 Contact name: H 1Z i fes'IL y Roof drain(commercial) 12.51 Address: Po ox /0 cD Sink/basin/lavatory 25.02 City/State/ZIP: wUc3 i) le.„)/ Ol p 9 7,1 7/ Solar units(potable water) 62.54 Phone:(97/ )Z 3 j ,s-0- Z y Fax: :(g 7() 2/6 - 00 7, Tub/shower/shower pan 12.51 E-mail: KC,g 12_i(=IZ iJ �21Z Lu-.)7124 -c jtjZ, . GO%.,..4 Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: •KI ,Z.r<Z„ c' onartcrolz,S d g/=6.e,,../ y„r✓C.. Water piping/DWV 56.29 Address: .)t �- ox (O(0Q Other: 25.02 City/State/ZIP: vo00i7(sue>N 0R. I 7o 7 1 Subtotal -775 L Phone:(ail! ) 7_1(p -00,51:1 / Fax:(97 J) Z.tt -00?1 Minimum permit fee: $72.50 2, CCB Lie.: I 9,c-6 Plumbing Lic.no.:.2II-Y..27 P� Plan review (25%of permit fee) 1 45410$ '°S-- - State surcharge(12%of permit fee) g•,lip Authorized signature: - - TOTAL PERMIT FEE `79, 33 Print name: K -� 7----,2_ Date: 9/3U/I' 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:iBuilding\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) F/. O 7-- oS`(533 5, trZ) 'Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities QY. Fee(ea} Total Square Footage: Permit Fee: 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 Sewer-1st 100' 62.54 3,601 to 7,200 $233.20 7S� a Z.�� 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. $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 Ins tions or Fees Qty. "Fee(ea) Total eceach additional$100.00 or fraction thereof,to h 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: 6Z,j 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/ Plan review is required for anyof the following. Work Performed: Capped Added Relocate q 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 ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain El 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" Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food q b 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 *Note: If the fixture work under this permit results in an Washer-Clothes Water Extractor increase of sewer EDUs,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\kcarter\Downloads\PLMU_PermitApp(1).doc 2