Permit CITY OF TIGARD PLUMBING PERMIT
11111
I COMMUNITY DEVELOPMENT Permit#: PLM2022-00492
T f GA It t) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1 2/612 0 2 2
Parcel: 2S112CA16100
Jurisdiction: Tigard
Site address: 7803 SW LAYTON LN
Project: Brookside, Lot 21 Subdivision: BROOKSIDE SUBDIVISION Lot: 21
Project Description: Backflow device.
Contractor: BRAVO LANDSCAPE Owner: BLACKWOOD HOMES INC
1153 VANDERBECK LN. PO BOX 4188
WOODBURN, OR 97071 TUALATIN, OR 97062
PHONE: 503-951-0208 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/06/2022 $31.27
Specifics: 1 12%State Surcharge- 12/06/2022 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 12/06/2022 $41.23
Class of Work: NEW 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.
Plumbing Permit Application
Building Fixtures FOR OFFICE usE ONLY
Cityof Tigard.. Received: , Permit No.: (i') 6Da,cc4'
g c�/,��, d
i ■ 13125 SW Hell Blvd.,Tigard,OR 97223 Plan Review
' Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: runs 67 See Page 2 for
Internet: www tigard
T 1 G A R D m gov Notified/Method. Supplemental information
•YVE 6F tVitc-, 41_.n=,.._... rr, ` _ : ,
For special ipfornrodon use checklist
■ r ■ Demolition Description I Qty. ) Ea. I Total
fij Addition/alteration/replacement ■ New 1-2-family dwelli •ts(includes 100 ft.for each utility connection)
500.32
■ Accessory building ■ Each 1
■ Master builder ■ Other:
r.1
Site utilities:
Catch basin or area drain 18.76
Job site address:.. j 03 3cc, O l----on L 27 1
rywell,leach line,or trench drain 18.76
rct Footing drain(no.linear ft.:____) Page 2
p
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
lEtain 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.:
7 J� ' r '2Z
-c > {0 11r , [ t c'C ( _'j Clothes vvasher 25.02
Dishwasher 25.02
DrinIcing fountainI
1
Name: P C l."-)CO • / Y v SFloor drain/floorI
Address: Garbage disposal 25 I
City/State/ZIP: Hose bib 25.02
Phone ( ) ,p` y :E E Fax:( )
Ice maker 12.51
�'^' k�,,Pit $ CrCf-t r 11Si xC ter . -,1Iriterceptor/grease trap
25.02
Business name: ¶a f \P_ c Ccan <IC---
Contact name: Roof drain(commercial) 12.51
Address: t
City/State/Z1P: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: 8/2Avo LcryiDSG2c_Y C Water piping/DWV 56.29
Address: ' c,, . -9'!LC - Other: 25.02
City/State/ZIP:WQ2. b i d2Ae. 7d2_9'' ---7/ Subtotal
�7�� Fax:( ) Minimum permit fee: $72.50
Phone:( � Plan review(25%ofpermit fee)
CCB Lic.:: p/ Plumbing Lic.no.: State surcharge(12%of permit fee)
Authorized signature, r I f�� TOTAL PERMIT FEE I-- a o
i -`O
/ � � t� �/�, Dale: �r'mil application eipires if•permitd is not obMktned wlthio :r days
Print name: after it Gas been accepte a campte
methodology set by Tri-County Building Industry Service Board,
I:lBuildurglPermits'PLMU-PermiIApp.din 10/01/09 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Su r t ression S stems:
'- Y . ,,e< ," " a .t `4tit .' et,€"-,C,A; t r:'t : i:,?. M.r _s�FJ,'J7, 1- . L, i -ut.4 ;-?" * A ,, .a-
"� .vt` r�x w•. _ Oto2,000 $121.90
Footing drain-1 100' 50.03
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 S stems:
Water Service-each additional 100'
';.[°iS,IL�..rs,1.t)S� Gz��r'.tt9.4: ��'i" ' -`'� 4 4.�)'
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
,'G ,t pi5: 'sYW"M t i Xj7,t�'S1�sn `> J'rr`r 1lug Ca yr f ati..' each additional$100.00 or fraction thereof,to
f �" [ _, 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 90.00Ru 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$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to y . .n.-+trip I �y�
t i -'Y D/}r `�xr + '.-. e "�
accurately report fixtures could result in increased sewer fees'v. �.;w FF 9 lt r4�
, Qdapttiy bVjVffit t i] ies Plan review is required for any of the following.
Fixtare'fype for '' - .k ' '`,'kert$etr:' Please check all that apply.
'-1T kPerforated _: C2p0-ed _.r 04d '.Rebtate:,
❑ 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 Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
ElAny 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" ,.., .,r -r.
a" 0 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: -LavBar 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 permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
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