Permit (6) 14 44 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00239
Date Issued: 6/14/2023
T[GARO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134CB02000
Jurisdiction: Tigard
Site address: 12145 SW SUMMER CREST DR
Project: Randall Subdivision: SUMMER HILLS PARK Lot: 19
Project Description: Installing backflow preventer for landscape irrigation.
Contractor: WRIGHTS PLUMBING Owner: RANDALL, SEAN A&LENORA R
13500 SE MAPLE LN 12145 SW SUMMER CREST DR
MILWAUKIE, OR 97222 TIGARD, OR 97223
PHONE: 503-449-8418 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/14/2023 $31.27
Specifics: 1 12%State Surcharge- 06/14/2023 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 06/14/2023 $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 i OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
T �
Issued By: Permittee Signature: C ( v!474
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 - . '•.°' 1
=1 FOR O111( I. US1; 0N1.1
Building Fixtures ,? g
Received /��� �/
City of Tigard atey: ll�/ la /�/ f °�U -( 7
111/ a 13125 SW Hall Blvd.,Tigard,OR 97223 t E. Review % Other permit No.:
t Ohh
Phone: 503.718.2439 Fax: 503.598.1960 ;,,°` i,:boor ®See Page 2 for
Inspection Line: 503.639.4175 Date Ready/By: kris:
Su elemageal Information
T l u n I I) Internet www.tigard-or.gov Notified/Method:
�,'� e For special information use checklist
❑New construction 0 Demolition Description I Qty. I Ea. I Total
�: Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
SFR(2)bath 437.78
lEr=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
J10 `51 t'%'. C`,, )l5"ii L-t LFr.,�tiFi} r 1 . € - Site utilities:
_ _ Catch basin or area drain 18.76
Job site address: / -) �_ /J � r�L �'(' Drywell,leach line,or trench drain 18.76
City/State/ZIP: (-4'e-`:-I` 1)P- ' Footing drain(no.linear ft.:__) Page 2
Manufactured home utilities 50.03
Project name:
Suite/bldg.lapt.no.: I j Cross street/directions to job site: Manholes 18.76
18.76
Rain drain connector
---Sanita ono.-linearft.:__)- Page 2
Storm sewer(no.linear ft.:__) Page 2
Water service(no.linear ft.:,_) Page 2
Subdivision: I Lot no.: Future or item:
Backflow preventer /
31.27
Tax map/parcel no.: Backwater valve 12.51
2�C,, I KC-) chi, '' Clothes washer 25.02
, : . 25.02
t y, (X A- Dishwasher 25.02
O '4 Q {Cc-)r^ 0, S f v\i��\e-� Drinking fountain
Ejectors/sump 25.02
;IF. Expansion tank 12.51
�',' tF)s? � c)fSE�, � ' �" 25.02
'+- Fixture/sewer cap
Name: e•--G�t v 61._VI O(4 f 1 Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02]2.51
Phone:( ) Fax ( ) Ice maker
_. . ,A
tr s_ �cfii h '";v A f',c§ -Ctc; 5 F �'Jts) ( tv, -. ., Interceptorgreasetrap 25.02
. '=-4' "' ,-q-ez-c 4 `a S .
Medical gas(value:$ ) Page 2
Business name: Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
Solar units(potable water) 62.54
City/State/ZIP: 12.51
Phone:( ) I Fax::( ) Tub/shower/shower pan Urinal 25.02
E-mail' _Water closet 25.02
`' a,," d.e~ t'? t '.' a 4 to''F2 :• " *" Water heater 37.52
ir
;/2 /60 /� 1i- Water i in WV 56.29
Business name: !�' (.-�!(,�(l�l i P P �
Other: 25.02
Address: t 3500 5 k �i - --- Subtotal
City/State/ZIP: yyk, l\,a ) Minimum permit fee: $72.50
Phone:(.SG73) `{ � -�z// Fax:( ) / Plan review(25%of permit fee)
CCB Lie.: f q(� 7 I �`�� Plumbing Lie.no.: 3-'zf T,c e6 State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature:
�^ / �_[; Date�/� _//� This permit application expires if a permit is not obtained within 180 days
Print name: t l A_ (�5 ex) i C-f t s� ( / a2� after it has been accepted as complete.
VVV��v 'Fee methodology set by Tri-County Building Industry Service Board.
l:\Building\Permits\PLMU-PermitADD.doc 10/07/09
440-4616T(7 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Feeyy Schedule: Residential Fire Sur b ression S stems:
;:,, i F y I_ U3 fi, -:"'ri .7 _y S'
's-_...z 4 WA, Z? ,,,)F'S Gk..... 1 .F, Y ozc€1d>*' ?) : €' .. �' [ Sft1�a5.y atm� .r ,,s- 3,
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 eater $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 V G b •r X 9 r .`
Stone&Rain Drain-1st 100' 62.54 �''�`i 1�` €s . ,i' s .
_ $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
each additional$100.00 or fraction thereof,to
1I NF 1 Kick_b(fir 4,: ` ([ Elk, ' fit'- �S i 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 char:e-1/2 hour and including$25,000.00.
Inspections outside of normal business 90.00/1u $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum char:e-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 char:e-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 rport fixtures could result in increased sewer fees*. '` i .)Af" , `~l 'c. �`s`e'* t'`` tI•31 '-1 i) *: ,
1- -
t r} i' -: ,"Wei • 4 Pfs,
""ieV Plan review is required for any of the following.
Frxre4or- �` r z p s Please check all that apply.
, , v .. _ ed A Ioca e,t'o Redo tined; .� ;± ..ma=.i d 4..s... ;4 ., : . ,...• 0 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
Domestic 0 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" _ -
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the .ualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
IceMach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -IavBar 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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