Permit CITY OF TIGARD PLUMBING PERMIT
N1 n COMMUNITY DEVELOPMENT Permit#: PLM2016-00305
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/14/2016
Parcel: 2S103DD00406
Jurisdiction: Tigard
Site address: 10815 SW FAIRHAVEN ST
Project: Meichtry Subdivision: FAIRHAVEN COURT Lot: 2
Project Description: Residential backflow preventer for irrigation
Contractor: RYAN CREEK LANDSCAPE Owner: MEICHTRY, VICTORIA&ANDREW
19215 SW EDY RD 10815 SW FAIRHAVEN ST
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-351-9979 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/14/2016 $31.27
Specifics: 1 12%State Surcharge- 05/14/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 06/14/2016 $41.23
Class of Work: OTR Plumbing
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 Notificatien_center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ma obtain a copy of the rules
or direct.crOestions to NC by in 503.232.1987 or 1.800.332.2344.
Issue By: L. - Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection te.
This permit card shall be kept in a conspicuous place on the job site until com eti n of the project.
Approved plans are required on the job site at the time of each in pection.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
Cityof Tigard RECEIVED Received /- �/ / , , n 0/ /12
g Date/By: (,(� �7 �� f\��Jr/ Permit No.: r ��VC/J�S
. • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503i J 9t 4 2016 Outer Permit No.:
V Date By:
Inspection Line: 503.639.4175 Date Ready/By: tuns
TIGARD Intentet: www.li and-or. ov it See Page2for
g g�.l�I1���p'}r(� �"�r_,7t(__.y 1'y Notified/Method: Supplemental Information
TYPNI-1 IM U G DIVISION. FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist
Description I Qty. Ea. I Total
❑ Addition/alteration/replacement Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(11 bath 312.70
MI-and 2-family g dwellin SFR(2)bath 437.78
❑Commercial/industrial
0 Accessory buildingSFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
og f. S �y . Catch basin or area drain 18.76
Job site address: J
l ( 1r Guc S1
q � �Z23 Drywell,leach line,or trench drain 18.76
City/State/ZIP: �
CC f�pp Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:PlL t C1t'f ri iec-S . Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
\`
S t-s.) / f V f L Li G Rain drain connector 18.76
rs Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear IL: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer / 31.27
DESCRIPTION OF WORK Backwater valve 12.51
( Clothes washer 25.02
d�,k_ .cld..% -'-'"L Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: �{ � Y Fixture/sewer cap 25.02
YlG`✓Gti V1c:Lv�, Plc
_ Floor drain/floor sink/hub 25.02
Address: /65`� S l..J PC-1✓ Q/ CV'''C.t-�
�_ Garbage disposal 25.02
City/State/ZIP: it e�� 9 7 ZZ 3 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
Gh �Cr7� LC-�CI S C-,t Primer 12.51
Contact name: J Lj y LC v
tt-
` Roof drain(commercial) 12.51
Address: /5� S Sc.) F^Y0- f7 ft Sink/basin/lavatory 25.02
City/State/ZIP: LcfwvU C
i 7/Y U Solar units(potable water) 62.54
Phone:(SJ3) 33[ g g 7 nj Fax::( ) Tub/shower/shower pan 12.51
E-mail: e Wi i d g EL MC<(l/ f Cd 1.y\ Urinal 25.02
j
.. . Water closet 25.02
CONTRACTOR
. Water heater 37.52
Business name: P•1 ark Waterm p p
t DWV 56.29
Address:
Other: 25.02
City/State/ZIP: c44 - 4i b< ?/,(() Subtotal
Phone:(0J3) 3 S( 5 5 7 / Fax:( ) L(--6 Minimum permit fee: $72.50 7a-st.)
Plan review (25%of permit fee) ------
CCB Lie.: 9 56-3 � Plumbing Lic.no.: State surcharge(12%of permit fee) �g.7o
Authorized signatur • TOTAL PERMIT FEE (/ O"
Print name: ‘ireliqj l t/Cr/�y Date:6- / /,` 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.
1:16uiIding'P its,PLMU-PemritApp.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) Total Square Footage: Permit Fee:
Footing drain-I" I OW 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 I00' 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 S72.50
Stone&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
P 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*. 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
Car Wash: Each Stall CI New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El 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"
Isometric or Riser Diagram
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
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10815 SW FAIRHAVEN ST, TIGARD, OR, 97223 May 3, 2018 at 11 :02:20 AM
Record Type: Record ID:
Residential - Plumbing PLM2016-00305
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
3/4" Wilkins backflow device model 350 ser#A546439 located by meter approved with
test report
Violation Summary:
Inspector Contractor