Permit (7) CITY OF TIGARD PLUMBING PERMIT
= COMMUNITY DEVELOPMENT Permit#: PLM2022-00294
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/1/2022Parcel: 2S104BA10700
Jurisdiction: Tigard
Site address: 13643 SW LIDEN DR
Project: Teaff Subdivision: CASTLE HILL NO.3 Lot: 137
Project Description: Installation of backflow preventer for landscaping.
Contractor: HORTUS LANDSCAPING Owner: TEAFF, JANET E TRUST
PO BOX 80283 13643 SW LIDEN DR
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503-407-3722 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/01/2022 $31.27
Specifics: 1 12%State Surcharge- 08/01/2022 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/01/2022 $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 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
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.
Plumbin Permit Application
Building Fixtures 9 IVEI '
City of Tigard iO�T lReceried
te !
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax 503.598.1�6p- "i Other Permit No.:
Inspection Line: 503.639.4175 1 '(Uj� � DateBy:
P , Date ReB Juns: ®See Page 2 for
Internet: www.tigard-or.gov `11t JING Y '
Notified/Method: Supplemental Information
❑New construction ❑Demolition For special information use checklist
Description I QtY. I Ea. I Total
❑Addition alteration/replacement Other. 0w New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
s4
a
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ElMulti-family
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
Site utilities:
Job site address: S'u-, i-1cktA J i v Catch basin or area drain 18.76
��� Drywell,leach line,or trench drain 18.76
City/State/ZIP: a,d Z
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.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
61Clothes washer 25.02
b Dishwasher 25.02
tj Drinking fountain 25.02
yM� Ejectors/sump 25.02
Expansion tank 12.51
- r �
Name �� Fixture/sewer cap 25.02
Jp Floor drain/floor sink/hub 25.02
Address: L N Vl Y1 Garbage disposal 25.02
City/State/ZIP: dr O T Z Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
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
Business name ![r{ ��N Water piping/DWV 56.29
Address: r Other: 25.02
City/State/ZIP: 62. 47 7t-_C> Subtotal
Phone:( c' 7zzlFax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
ai Qkdiir,,; 131
Plumbing Lic.no.: o
/j State surcharge(12%of permit fee)
Authorized s I re: /` TOTAL PERMIT FEE
Print name: Date: 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:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/C0M/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
Footing drain-V 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-1 st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems'
Water Service-each additional 100' 37.52
Storm&Rain Drain-1 st 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
each additional$100.00 or fraction thereof,to
ME 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 I 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'. 4 WD
Quau ,"Ifrtre "' a Plan review is required for any of the following.
Ptxture y.
Ve4',r :`� "As6tace� Please check all that apply.
orh Plbrf rabfedi upped AddItslocate
ed
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/WhirlpDol
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water idor/Water As irator ❑ 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"
4» Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refri .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:
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