Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00392
Date Issued: 11/13/2023
TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S106DC21100
Jurisdiction: Tigard
Site address: 13912 SW 172ND AVE
Project: Riverside at Scholls Meadow,Lot 48 Subdivision: RIVERSIDE AT SCHOLLS MEADOW Lot: 48
Project Description: Backflow device 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 11/13/2023 $31.27
Specifics: 1 12%State Surcharge- 11/13/2023 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 11/13/2023 $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: Parmittee Signature:,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 71e�
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 O\l.l
City of Tigard B 4 l33#ceive: �\�;n'n� Ni/ Permit No.: q,syiCey
IIIq 13125 SW Hall Blvd.,Tigard,OR 97223 ` Pbn Re: 1 w u I
Phone: 503.718.2439 Fax: 503.598.1960 # Plan Review �c n y�
DateBy: Other Permit No.: C L1_1 tiv tV d
Inspection Line: 503.639.4175 " "- Date Read/B Jnris: ® See Page 2 for
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TIGARD y y g
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
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❑✓ New construction fDe ition ` 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)
(` '•' SFR(1)bath 312.70
❑✓ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
['Master builder 0Other: Fire sprinkler( sq.ft.) Page 2
,fi otf` s: w *ilk I a Site utilities:
Job site address: 13912 SW 172nd 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.: 1 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 ft.:_) Page 2
Subdivision: Riverside at Scholls Meadow Lot no.: 48 Fixture or item:
Tax map/parcel no.: WCTM 2S106DC21100 Backflow preventer 1 31.27 31.27
" Backwater valve 12.51
-rod r�="'� .,:, .Ya x ' - '�,� � w �`ea�idux'�R� Y^ti-.;,^ �� �..
,'-a':' i,..,, - :. .A ,�.. �..� i x r a--- T u b l' r Clothes washer 25.02
Construction of single family detached residence -
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
`''" t rr Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Riverside Homes
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
V f �► ; < 4 :k4 f Y, "
, , Interceptor/grease trap 25.02
Business name: Riverside Homes Medical gas(value:$ ) Page 2
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
Urinal 25.02
E-mail: jdoty@riversidehome.com
4 .., r oa Water closet 25.02
- tad'r •'''-r' --' '" , may
�� �' Water heater 37.52
Business name: Truscapes Water piping/DWV 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
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: LCB #7962 State surcharge(12%of permit fee)
Authorized signature: _ TOTAL PERMIT FEE 0`..10
Print name: Jennifer Doty Date: 2/6/23 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.
C\Building\Permits\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 Su• •ression S stems:
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 S stems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 `" t r f
$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
c° each additional$100.00 or fraction thereof,to
m 2 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
(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*.
f Quantity t#1 � ' ' 4 ' I 0 B F ' 1. ' t at
Fixture Type fW
- ork Perfa C Plan review is required for any of the following.
n " Please check all that apply.
Baptistry/Font pp y'
ElBath Tub/Shower Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher Commercial 0 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"
Car Wash Drain _r
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings ._
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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