Permit (3) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00145
Date Issued: 4/24/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S111CA11500
Jurisdiction: Tigard
Site address: 9589 SW LAKESIDE DR
Project: MOSELEY Subdivision: SUMMERFIELD NO.12 Lot: 653
Project Description: Backflow preventer for irrigation.
Contractor: BEST PRICE PLUMBING &DRAIN LLC Owner: MOSELEY LIVING TRUST
4130 SW 117TH AVE 160 9589 SE LAKESIDE DR
BEAVERTON, OR 97005 TIGARD, OR 97224
PHONE: 503-992-6249 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/24/2023 $31.27
Specifics: 1 12%State Surcharge- 04/24/2023 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/24/2023 $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:
C//II//ll 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 IIIIIIIEIIIIIIIIIIIIIIIIIIIW
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City of Tigard REC E IV to y / //J Permit No.: D4ir 3- of 41)
■ 13125 SW Hall Blvd.,Tigard,OR 97223 evicw Other Permit No.:
I Phone: 503.718.2439 Fax: 503.598,1960 Date/By:
Inspection Line: 503.639.4175 APR 2 4 202 date Aeady By: runi 67 see Page 2 for
T I l;A I U ohfed/Method. Supplemental Information
Internet: www tigard or gov �, ,, .�
' Far special information use checkiist
❑New construction D DenmINEILDING D.1 'J . N Description I Qty. I Ea I Total
ja.,Additionialteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
SFR(l)bath 312.70
SFR(2)bath 437.78
E.1-and 2-family dwelling 0 Commercial/industrial 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
- -- -- - ix
Catch basin or area drain 18,76
G/'sl�
Job site address: q �� L /r2 Tf7TU Drywell,leach line,or trench drain 18.76
City/State/ZIP: j=o_...„1,_,t -D Q/? /1)(35e-1,< y Footing drain(no.linear ft.:__) Page 2
Suite/bldg./apt.no.: I Project name: +J r Manufactured home utilities 50.03
Manholes 18.76
Cross street/directions to job site: 9 4- T 18 76
Rain drain connector
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:
Backflow preventer / 31.27 j! Z .
Tax map/parcel no.: Backwater valve 12.51
`)a1!,C ? VI`r � ) ;ci, ,z 25.02
_ . ._ - Clothes washer
gt't Pz A F/i' c2 I z? .D,,,c,9 !C i /iirZ Plc,Plc, Dishwasher 25.02
Drinking fountain 25.02
f,1j4! /27i_ Ejectors/sump 25.02
r - - - Expansion tank - 12.51
, :J;?,�Ic !.: �., i I . . . -
_ _ . - _ - Fixture/sewer cap 25.02
Name: .S L Jzi9 //)r2s/t L,>/ n Floor drain/floor sink/hub 25.02
Address: 9$g'j 5-� j.}!-r - 5 =/7 i7 P,` Garbage disposal 25.02
City/State/ZiP: T�G,„„ii_A /7 Hose bib 25.02
Fax:( ) Ice maker 12.51
Phone:( 5a3) $'2! 5 - ; r- � � � Interceptor/gease trap
o- zE ' yr iC - C.-V J t ' r
25.02
n . r '�:< i - . Medical gas(value:$_) Page 2
Business name: g rZ 7- Par//s P/r I/A/7--✓,--- /1 ` Primer 12.51
Contact name: L 1..' try icks,z.
6'Too_,-,-4,4..7 Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP:
Solar units(potable water) 62.54
Phone:( ) I Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: Water closet 25.02
ti
c .er -. $' 'k`}�' rye '� i '; - ': 37.52
°;<. y f F , ',� -: . , � r' Water heater
Business name: 8)-ZS)- p, -1- c' i-L Pt- J/4[SiAX, Water piping/DWV 56.29
25.02
Address: eye/ '�D Sat) / t 7 t t!/4'(/r7 At 1/2� Other: }
�
�
/� .7
City/State/ZiP: 1-3/{/{ !I(j A %� c/ v tir `n�� Subtotal J Minimum permit fee: $72.50 -71.2
Phone:(i7X17) r7 7 7 --6 2 4'9 Fax:( )
Plan review (25%of permit fee)
CCB Lic.: 2c?6, 2 SS- y'Ih ear Plumbing Lie,no.:sfgy S-7
State surcharge(12/o of permit fee) y-.7J
Authorized signature: -)---a-�---_ ---' TOTAL PERMIT FEE 8) ,
2-0
_ This permit application expires if a permit is not obtained within 180 days
Print name: /, i✓ j� 1'i 2 5 i ,4 !O/t! Date: d! [t p � after it has been accepted as complete.
e� "Fee methodology set by Tri-County Building Industry Service Board.
1:1BuildtngtPermltstPLMU-PermitAPPdac 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Sur r ression S stems:
•" yg, '.: '. �"v t y a .r i � ...y, i i l }. �.#,sd{ a P,;y, ?fit i. " ter.-:
Footing drain-I"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-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 ‘�,y EEt `�rr , - -,1� r q t 'a 17 ` " ' ' k
r .�S ii rs.S0 ,r ;1: :. 15 1• =.., t k '',",,,:,a '..ga'
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
1�. h� y't� "x)'ty4 k a e '1 O]�,"'s`; .. and ineach curtional$100.00 ding$10,000.00.r fraction thereof,to
f
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 S742.00 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
r
accurately report fixtures could result in increased sewer fees*. Yi ti s I `", '='
r ,.-* x k ' , ,g-Qr7antlt hb`iF'9tillziype* ° Plan review is required for any of the following.
Fr%trireyeor "3y pcer< Please check all that apply.
'Wotk;Perfo died - r Ce 04 Aa 31e, L11191 3ret•
'i ❑ 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
W ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
0 Any complex structure as defined in OAR918-780-0040.
Domestic
Drinking Fountain
Eye Wash Submit l sets of plans with any of the above.
Floor Drain/sink. -2" * . .,,•=1
3„ man
-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
lee 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:
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