Permit CITY OF TIGARD PLUMBING PERMIT
tt • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00227
T l G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/09/2012
Parcel: 2S108AB05400
Jurisdiction: Tigard
Site address: 14217 SW 155TH TER
Project: Brentwood Estates, Lot 16 Subdivision: BRENTWOOD ESTATES Lot: 16
Project Description: Installation of residential backflow preventer for irrigation
Contractor: TRADEMARK LANDSCAPES INC Owner: STEEL CREEK HOMES LLC
P. O. BOX 2410 7327 SW BARNES RD #507
OREGON CITY, OR 97006 PORTLAND, OR 97225
PHONE: 503 - 631 -3893 PHONE: 503 - 519 -6078
FAX: 503 -631 -4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/09/2012 $31.27
Specifics: 1 12% State Surcharge - 08/09/2012 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 08/09/2012 $41.23
Plumbing
Class of Work: OTR
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 • 'cation e - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obta'r a copy of the rules
or ect que tions to OUNC I 503.232.1987 or 1.800.332.2344.
Iss • ed By: 4411f.41111, �• 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 Application ��, R
A ..i r I-
.' la ?.1., Fol? c)rl lcl: usl: oNl,�
City of Tigard AUG 0 9 2012 Received „mama Permit No.: ' M
a 13125 SW Hall Blvd., Tigard,OR 97223
Phone: 5037182439 Fax: 503598196 Plan Review
4 . . . . l t Other Permit No.:
Inspection Line: 503.639.4175 �� F sir y
T I G R U P 1 1 �u ` l`�°' y Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov
null. i � pf� . rz i o [t Notified/Method: Supplemental Information
TYPE OF WORK Jli F' Jt FEE* SCHEDULE
KNew construction ❑ Demolition 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
A 1- and 2- family dwelling . ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
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: /1�7i ' � J i r5" / c Catch basin or area drain 18.76
�� C � r ''� A r Drywell, leach line, or trench drain 18.76
City/State/ZIP: I f ! //`
Ci 9
ty ✓ l 7 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: h0 / CC Manufactured home utilities 50.03
Cross street/directions to job site: 6 v i 1 f ' p , Manholes 18.76
t Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
-1 / Water service (no. linear ft.: _) Page 2
Subdivision: * , t ,,� pp I Lot no.: / lD Fixture or item: .
Tax map /parcel no.: Backflow preventer 31.27
DESC IPTION OF WORK Backwater valve 12.51
• Clothes washer 25.02
AAA") (,? 4f" V �/ t Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERT OWNER / I ❑ TENANT Expansion tank 12.51
Name: .._.... -1-. 1 .... e . f /� � - t - Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 7341 ! iz„1/4) K - f > l' Z d / -1 j�
Garbage disposal 25.02
City/State /ZIP: 0% ( N I - ( vY� q 7 Hose bib 25.02
Phone: v23) 57 q -6107 � Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CPNTACT PERSON Interceptor /grease trap 25.02
Business name: //�� L IM r ...e....5 Medical gas (value: $ ) Page 2
% I ,..c � C�'�C -L -( rc
b I
Primer 12.51
Contact name: r t ,,, t
,� j �j Roof drain (commercial) 12.51
Address: ' 7 `T j ,� v� 4* Sink/basin/lavatory . 25.02
City /State /ZIP: 01.,...t. / g7ZZ s Solar units (potable water) 62.54
Phone: (3) Fax:: ( _ Tub /shower /shower pan 12.51
• A AA/ 1 1 0_..6 - 1-x,( /e.r'q"( (- E-Lat" ) L-es, ,,,....c.---1-- Urinal 25.02
E -mail: GV
CONTRACTOR Water closet 25.02
r p � � c Water heater 37.52
Business name: S L 0.45. Water piping/DW V 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: (3) 3274 Fax: ( ) _ Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:�1,. x j Date:/a/ This permit application expires if a permit is not obtained within 180 days
/ 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/WBB)
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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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
Other Inspections or Fees Qty. Fee (ea) 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 $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) 1 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 $50,001.00and 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 ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Tub /Sr ❑ New exterior plumbing site utilities for any complex structure
Bath - hower
Tub /S owerlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 -780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain %
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ _ Isometric or riser diagram is required for new buildings
3 l
that meet the qualifications above. '
Car Wash Drain '
Garbage - Domestic , .
Disposal - Commercial
•
- Industrial Comments regarding fixture work:
Ice MachiRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station . • •
Shower -Gang
-Stall . _
Sink - Bar/Lavatory - ,
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
plumbing permit can be issued.
Water Extractor p g p
Water Closet - Toilet
Urinal
Other Fixtures:
I: \Building\Permits\PLM- PermitApp.doc 2
Backflow A can too3) 289'1745 - 2073639254
Assembly $aCkflOW1, w " " k NEW
Test Report ,Es#ThTe a REPAIRS service s 1 ❑ E aSTING
a6 INSTALLATION ❑ REMOVED
❑ REPLAQFMENT •
Owner Steel Creek Homes Lot #16 Phone:
Mailing
Address:
City: State: Zip:
Assembly
Address: SW 155th Ave Tigard OR 97223
❑R.P.B.A L .D.C.V.A [IR.P.D.A 0D.C.D.A fP.V.B.A LiS.V.B.A . 0 AIR GAP
l ° ��c M I: ! jAV
7�/
Size: Make:
Water Serial L 55 7c 2
Purveyor: / Tiigga � rd / Number.
Location: / � f ' e e p 4ezt3e
REDUCED ASSEMBLY - - P.V:B.A tS:V:B.A INITIAL TEST
#1 CHECK I DOUBLE CHECK AIR INLET CHECK PASSED
• RESS DROP LZ I CHECK #1
RELIEF VALVE I OPENED AT: PRESS DROP FAILED
INTL OPENED AT (B) I TIGHT 1 PSID �:
MIN 2 PSID I LEAKED
RESULTS BUFFER A PSID PSID i //Z
B = -I __ _CHEa n .
RECOMEND 2 P510 I T/G V L. _ DI pNI . FAILED_ .. - 7Ey e,
RELIEF VALVE t OPEN U I' ❑ P - Go 6
PASS I f FAIL El I LEAKED n P ''D PSI
'r n #1 Shut Off
J Rusted Off
COMMENTS ��
D / O US U® ' 'y� D I r ilk Shut Off
AND / S � \ ME 0 � U Rusted Off
PARTS
REDUCED PRESSURE ASSEMBLY P.V.B.A / S.V.B.A AFTER REPAIRS
#1 CHECK I DOUBLE CHECK DATE:
TEST PRESS DROP (A)ICHECK #1
AF RELIEF TIGHT ❑ PSID OPENED AT: PRESS DROP /
REPAIRS OPENED (B) I
BUFFER " 1Ps ICHECK #2 PSID ps D PASSED
A B �m,3MD I TIGHT ❑ P510
IN COMPLETING AND SUBMITTIN • IS '% PORT, THE TESTER CERTIFIES THAT THE ASSEMBLY HAS BEEN TESTED AND
MAINTAINED IN ACCORDANCE • t • LI' • :LE : AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS.
WATER METER # / , I t R METER READING
r / wasnington CERT#
/ 5523
TESTERS SIGNATURE Oregon CERT#
Mason Yung : ' erg #20920
TESTERS PRINTED NAME GAUGE #
American BaciElow Services (503) 289 -1745 02 -26 -12
COMPANY NAME PHONE # GAUGE CALIBRATION DATE
5905 N Interstate Ave, Portland, OR 97217 SERVICE RESTORER
ADDRESS WATER FOUND ❑ OFF