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CITY OF TIGARD PLUMBING PERMIT
•
COMMUNITY DEVELOPMENT Permit#: PLM2022-00355
Date Issued: 9/8/2022
TFGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111DC00900
Jurisdiction: Tigard
Site address: 15820 SW ALDERBROOK CIR
Project: GUSTAFSON Subdivision: SUMMERFIELD NO.8 Lot: 456
Project Description: Backflow preventer for irrigation.
Contractor: SHOWPLACE LANDSCAPE SERVICES Owner: GUSTAFSON, DEAN &GLORIA
PO BOX 746 15820 SW ALDERBROOK CIR
WILSONVILLE, OR 97070 PORTLAND, OR 97224
PHONE: 503-682-6066 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/08/2022 $31.27
Specifics: 1 12%State Surcharge- 09/08/2022 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 09/08/2022 $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 copOf 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.
I
Plumbing Permit Application
Building Fixtures
City Tigard EVE celved , / PmNo:
Date/By: /I( 01/�?-a-011353II/ 131 SW Hai]Blvd.,Tigard,OR 972 •^" Plan Review• ■ Phone: 503.718.2439 Fax: 503.598.1960 8 2022 Date/By other Permit No.:
T I G A R D Inspection Line: 503.639.4175 S�rp Date Ready/By. tuna ®See Page 2 for
Internet www.tigard-orgov Tiati.BU NotifediMethod Su ,kmeatallnformaboo
TYPE OF WORK T _ - - c::
_ QtBIn1NGl.-1
❑New construction [3 Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
CAT.. I •Y OF CONSTRUCT;et..., SFR(I)bath 312.70
4 'rmmercial/industrial_ SFR(2)bath 437.78
❑I-and 2-family dwelling 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
-- .-,1 t SITk. h t RMA ION AN1) LOCI e-` I Site utilities:
- �..
rL Catch basin or area drain 18.76
Job site address:
t .c e O 5<.� / I j i K I�a c t-- C.T Drywell,leach line,or trench drain 18.76
City/State/ZIP: ci 72 Z4.. Footing drain(no linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Dkric4rJ 6.u51-i,.-5c7,„/ 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer i 31.27 3/,r-]
c
-- - - - Backwater valve 12.51
[)c,i e file r ' `C”.,::
Q [, - - - Clothes washer 25.02
r ( ,` b./f 1 Ybgt^.4C✓ ]ay' I rri_.hZ*../ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
i)� 3 4' c* Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( )
Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: �� n Medical gas(value:$_) Page 2
g(n,c>w r� A.c.0 i. eLn1c1 S C-/At• I`S y` Primer 12.51
Contact name: r--v , t ?A (( �/ t Roof drain(commercial) 12.51
Address:2 q 3 75 �,,,,,/a L-t ls,rvl 1=c- 4.7 14 ci Sink/basin/lavatory 25.02
City/State/ZIP: i(,t ail i2 w,„,..r_,j rat
Solar units(potable water) 62.54
Phone: V3) 6 82 666 Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: ^�Ltvn 7/ I _ . c.-'T
* eA r71,e Y-3^ ,"gt e r.)R0.Y. .t c ,<<" .x r Water closet 25.02
„rr,'#rr�,P n_P..s,: *�� .'�� - ' _ Water heater 37.52
Business name: JA> Le ) ,,1301J c, Waterpiping/DWV 56.29
Address: Other: 25.02
City/State/ZIP. Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7;
5-0
CCB Lic.:
/36 g I/3 j'1-�
Plumbing Lic.no.: Plan review (25%of pennit fee)
State surcharge(12%of permit fee) $ 70
Authorized signature: TOTAL PERMIT FEE�t),
Date:7 /{pO Z This permit application expires if■permit is not obtained within ISO days
Print name: L �s L IQ !�(S p�)KL r ` after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1BuildioglPermns1PLMr1-PernulApp.doe 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:
Qty. Fee(ea) Total • ar Foota, e ' P rm t. LC
Site jTttll Lt. �, .g l , -,_s-, ,.. . x. _
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2 00 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 S stems:
Water Service-each additional 100' 37.52
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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other.lnspection,�C or Fees 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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.
`'iVorkPertdrmed: 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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thai ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
Isometric or Riser Diagram
-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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/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 EDOs,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:
1:\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2