Permit (21) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00492
T t t;A h T? 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2023
Parcel: 2S112CB21700
Jurisdiction: Tigard
Site address: 15182 SW 81ST AVE
Project: Bella Meadows,lot 2 Subdivision: BELLA MEADOWS
Lot: 2
Project Description: Backflow device for irrigation
Contractor: TRUSCAPES INC Owner: BIG-VUK PROPERTIES LLC
21600 NW AMBERWOOD DR. PMB 360
HILLSBORO,OR 97124 4931 SW 76TH AVE
PORTLAND,OR 97225
PHONE: 503-531-9216 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/22/2023 $31.27
Specifics: 1 12%State Surcharge- 11/22/2023 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 11/22/2023 $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. Si-cility Code. and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work i not/start-. hin 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow e riles .o. -. by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090,'You may o/btai a q py of e r
dd /
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 )Er'F7 ‘
Building Fixtures
`��'4/ R Received
City of Tigard k, �7 :� y: 't1�, off. Permit No.: (� 63 '� 1
Date/By:SW Hall Blvd.,Tigard,OR 97223 f Plan Review
Phone: 503.718.2439 Fax: 503.598.1 FYIT� O TIGARD Date/By: Other Permit No.:
T IGA KD Inspection Line: 503.639.4175 1:.11L 'INP r±i I,Q,n(y Date Ready/By: rl r �/� 7yy}}��s: See Page 2 for
Internet: www.tigard-or.gov Notified/Method: t 1/t / . 1'Cr n l . Supplemental Information
TYPE OF WORK FEE* SCHEDULE
I ew construction 0 Demolition For special information use checklist.
Description Qty. Ea. ( Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
tgt -and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION` Site utilities:
Job site address: i 5 g2_ s,0 �` Catch basin or area drain 18.76
City/State/ZIP: 'r Drywell,leach line,or trench drain 18.76
t r✓(c
�J Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 64 I 14ki q ,„,1S Manufactured home utilities 50.03
Cross street/directions to job site: ]-'2 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
AC',-�1..-1.14-' ' ' I'
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: ri ,b Vol,1, LLL
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
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: \/,‘�14- 4 Ci/ a 4� LLC-
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: A„vii i, ? Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Yl`t,L yc 0vt,.•� VvLbt.t . Cvwn Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: k w SC S Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: ,\\SID tti J O IC Subtotal
Phone:( ) Fax:( )
Minimum permit fee: $72.50
q Plan review (25%of permit fee)
CCB Lic.: ,./..-.), Plumbing Lic.no.: (a
State surcharge(12%of permit fee)
Authorized signature: / g 3c l iA TOTAL PERMIT FEE
.. c..1
Print name: -•° Cit This permit application expires if a permit is not obtained within 180 days
,y1.�3� Date: Ql Z�� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 4404616T(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 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 Inspections 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
(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*. 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.
Work Performed: 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
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Corator ial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" 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
Ice Mach./Refrig.Drains Comments regarding fixture work:
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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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