Permit CITY OF TIGARD PLUMBING PERMIT
' a • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00063
TIGARD . 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 02/21/2013
Parcel: 2S111AD13100
Jurisdiction: Tigard
Site address: 8910 SW REILING ST
Project: Wolfe Subdivision: SCHECKLA PARK ESTATES Lot: 28
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: OWNER Owner: WOLFE, PATRICK J & HELEN S
8910 SW REILING ST
TIGARD, OR 97224
• PHONE:
PHONE 503 - 620 -0697
FAX.
FEES
Quantity , Description Date Amount
1 ea Backflow Preventer 02/21/2013 $31.27
Specifics: 1 12% State Surcharge - 02/21/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 02/21/2013 $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
Utili •• • i ication —ter Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
• •irect questions to OU C b - -fling 503.232 1987 or 1.800 332 2344.
Issued By: #, / 1 / Permittee Signature:
I—•
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 ApplicaEc fo r . %
Building Fixtures j i_.. __�
ed .2 A ic .
City of Tigard FEB 2 1 2013 Received Permit No • � QO
Date/By. e iv 4 a0�
11111 I q 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
Phone. 503.718.2439 Fax. 503 Z 9t f TIG /} A f Date/By: Other Permit No.:
Inspection Line: 503.639.4175 hJ/ 17f1 Il� D R /B lures ®See Page 2 for
Internet. www.tigard- or.gov
TIGnKD BUILDING DtVIS�( y y g
I �, Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
❑ Addition /alteration/replacement ther: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CO STRUCTION SFR (1) bath 312.70
r SFR (2) bath 437.78
` /1 � `- °red 2- family dwelling ❑ Commercial/industrial
building SFR (3) bath 500.32
❑ Accessory g ❑ 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: Si ICI S W �, � Pel CDT Catch basin or area drain 18 76
i1 Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tl(e1k�C et O za._/ Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name - S 1F 1
p r % \ g� A. Manufactured home utilities 50 03
Cross street/directions to job site: G e ., s r t 7 sci l 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: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer ' 31 27
DESCRIPTION OF WORK Backwater valve 12.51
p r Clothes washer 25 02
!�
f'eOM --, ..A +.- sr !' l.✓ S . j• s-11 `sue.. Dishwasher 25 02
Drinking fountain 25 02
Ejectors /sump 25 02
kc PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25 02
Name: QAtrizA, Lt J - l..ot7t_ct= Floor drain/floor sink/hub 25.02
Address: g9 t0 5� I (2.K\u. sT
Garbage disposal 25 02
City /State /ZIP: '�� C1 A --. . a(�Z C —4 .2.2.4 Hose bib 25.02
Phone: ('03) ( a O 0 Fax: ( ) jJf'.A Ice maker 12 51
(r APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
Business name:
�� Medical gas (value $ ) Page 2
Contact name: QkT�xCt� '5. �, c..
Primer 12 51
Roof drain (commercial) 12 51
Address: '( ip Sup Zi:I a ST Sink/basin/lavatory 25.02
City/State /ZIP: T 4 �p 1 u . -1 q1-12.-4A Solar units (potable water) 62 54
Phone: (CC GZQ DO. q 7 Fax:: ( ) d Mc Tub /shower /shower pan 12.51
E -mail: I`/A4 Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: C?).) Other: 25.02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7,2- 3 0
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) '��
State surcharge (12% of permit fee) 8
Authorized signature: ,...-/ TOTAL PERMIT FEE gj. otp
Print name / • Date: 2 _ 2 1- W �) T his permit application after
it expires has beem it a permit is as mot obtaimed within 180 days
-
accepted complete.
*Fee methodology set by Tn -County Building Industry Service Board
1 \Buildmg\Permits\PLMU PermitApp doc 10/01/09 440- 4616T(10 /09JCOM/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 & Ram 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
Other ec
Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspections 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
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
- Jacuzzi/Whirlpool
Car Wash. Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial ❑ 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
Garbage Domestic non -food that meet the qualifications above.
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 - Lav/Bar 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:
1:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
8910 SW REILING ST, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
04/12/2013 00:00
PLM2013-00063
PASS - No C of O
3/4" Wilkins mod 950 XLT S/n 366112
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
8910 SW REILING ST, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
04/12/2013 00:00
PLM2013-00063
PASS - No C of O
3/4" Wilkins mod 950 XLT S/n 366112
Violation Summary:
Inspector Contractor