Permit (9) n CITY OF TIGARD PLUMBING PERMIT
I° ' ' COMMUNITY DEVELOPMENT Permit#: PLM2023-00232
Date Issued: 7/3/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106DC21800
Jurisdiction: Tigard
Site address: 13869 SW 171ST AVE
Project: Riverside at Scholls Meadow,Lot 54 Subdivision: RIVERSIDE AT SCHOLLS MEADOW Lot:
Project Description: Backflow preventer for irrigation.
Contractor: TRUSCAPES INC Owner: RIVERSIDE HOMES LLC
21600 NW AMBERWOOD DR. 15350 SW SEQUOIA PKWY STE 320
HILLSBORO, OR 97124 PORTLAND, OR 97224
PHONE: 503-531-9216 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/03/2023 $31.27
Specifics: 1 12%State Surcharge- 07/03/2023 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 07/03/2023 $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 o //rules///�
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Issued By: Permittee Signature:
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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.
r 'Plumbing Permit Application
Building Fixtures RECEIVE - FOR OFFICE USE ONLY
Cl of Tigard l ate/Be n I I y I jai 3 ' p /V LM i, -
`J ll Permit No.: /)�j ,/lam/2
• 13125 SW Hall Blvd.,Tigard,OR 97223 Dan R : (/V (JV(JJ
i g 1 1 2023 Plan Review
1111 Phone: 503.718.2439 Fax: 503.598.1960 qpR LJ Date/By: Other Permit No.: 1\11S 1413,t\0tSS
Inspection Line: 503.639.4175
l 11.,A Kt) y ® See Page 2 for
vv Internet: ww.ti and-or. ov Date Read yB : Jmis:
g B Notified/Method: Supplemental Information
TYPE OF WORK 4 ON c • MO • FEE* SCHEDULE
a New construction EiDemolition 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)
CATEGORY OF CONSTRUCTION SFR(1)bath ' 312.70
❑✓ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
El Accessory buildingSFR(3)bath 500.32
El
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION 11 Site utilities:
Job site address: 13869 SW 171ST Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard/OR/97140 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Riverside at Scholls Meadow Manufactured home utilities 50.03
Cross street/directions to job site: Roy Rogers&Jean Louise Rd 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 IL: ) Page 2
Subdivision: Riverside at Scholls Meadow Lot no.: 54 Fixture or item:
Tax map/parcel no.: WCTM 2S106DC16100 Backflow preventer 1 31.27 31.27 ,.
DESCRIPTION OF WORK Backwater valve 12.51
Construction of single family detached residence clntneswasher 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑✓ PROPERTY OWNER ❑ TENANT,,„ -..,4 Expansion tank 12.51
Name: Riverside Homes
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 15350 SW Sequoia Pkwy, Suite 320
Garbage disposal 25.02
City/State/ZIP: Portland, OR 97224 Hose bib 25.02
Phone:(971 ) 371-1310 Fax:( ) Ice maker 12.51
❑✓ APPLICANT o CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Riverside Homes
Primer 12.51
Contact name: Jennifer Doty Roof drain(commercial) 12.51
Address: 15350 SW Sequoia Pkwy, Suite 320
Sink/basin/lavatory 25.02
City/State/ZIP: Portland, OR 97224 Solar units(potable water) 62.54
Phone:(971 ) 371-1310 Fax::( ) Tub/shower/shower pan 12.51
E-mail: jdoty@riversidehome.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Truscapes Water PP P�1 m WV 56.29
Address: 7800 NE Walker Road Other: 25.02
City/State/ZIP: Hillsboro/OR/97124 Subtotal
Phone:(503)531-9216 Fax:( ) Minimum permit fee: $72.50
LCB #7962 Plan review (25%of permit fee)
CCB Lic.: PlumbingLic.no.: State surcharge(12%of permit fee)
Authorized signature: ,L3,e.z__ TOTAL PERMIT FEE
Print name: Jennifer Doty Date: 2/6/23 This permit application expires if a permit is not obtained within Igo days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
l:lBuilding\P<mtits\PLMU-PermitApp.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-1"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 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 fcc$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
Other Inspections or Fees Qty. T' «) Total each additional$100.00 or fraction thereof,to
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 S1.54 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool rlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Tluu ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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