Permit n CITY OF TIGARD PLUMBING PERMIT
g COMMUNITY DEVELOPMENT Permit #: PLM2013 -00180
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/10/2013
Parcel: 2S 104BA00300
Jurisdiction: Tigard
Site address: 12010 SW WESTBURY TER
Project: DeLucia Subdivision: COTSWALD MEADOWS NO.3 Lot: 84
Project Description: Installation of residential backflow preventer.
Contractor: PREFERRED LANDSCAPE SERVICES INC Owner: DELUCIA, LINDA R
380 NW 336TH AVE 12010 SW WESTBURY TER
HILLSBORO, OR 97124 TIGARD, OR 97223
P
PHONE: 503 - 267 -3951
HONE: 503 - 764 -2321
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/10/2013 $31.27
Specifics: 1 12% State Surcharge - 06/10/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 06/10/2013 $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
issuan - :. is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules ad• �ted by the Oregon
Utili.• Notification Cent- . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. Y.0 may ob .1a copy of the rules
or : irect questions to OUNC • • in• 503.232.1987 or 1.800.332.2344.
Is ed By: /1 � � _ Permittee Signature
Call 503.639.4175 by 7:00 a.m. for the next available inspection d =.
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
R eceived D
City of Tigard Permi No.:
III a 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: �0 3 �1�jZo 5 /SO
Pl
C Phone: 503.718.2439 Fax: 503.598.1960 an Review
Dan Other Permit No.:
T I G A K D Inspection Line: 5013.639.4175 Date Ready/By: Juris: 62 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
New construction ❑ Demolition For special information use checklisL
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
V I 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
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: 0 (, N , � Catch basin or area drain 18.76
ty 1 1' O� ` � Sw �� f Drywell, leach line, or trench drain 18.76 le City/State/ZIP: P } k„ ^ dl O
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 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
1'� Clothes washer 25.02
Lc K IJw Fetter' ' Dishwasher I 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
14 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: L � D I �L ∎� Fixture /sewer cap 25.02
Address: 01) O S f �C Floor drain/floor sink/hub 25.02
P S - bury 'afr Garbage disposal 25.02
City /State /ZIP: pt },u/`(/t / n e cr7ZZ3 Hose bib 25.02 '
Phone: (S03 ) 267 3551 Fax: ( ) Ice maker 12.51 ,
❑ APPLICANT Ilk CONTACT PERSON Interceptor /grease trap 25.02
Pee ea( /..e.tv.,04sccet ` Medical gas (value: $ ) Page 2
(
Business name: �� 1 es
Contact name: S-+&.& (o � Primer 12.51
Roof drain (commercial) 12.51
Address: 3 ,O ,t, ki 3 R g ')+` ✓, Sink/basin/lavatory 25.02
City /State /ZIP: '-)- 1) s l�r. t O`Z_ 9-71/`-1 Solar units (potable water) 62.54
Phone: ($103 ) -'b t _ �3 Z 1 Fax:: ( ) Tub /shower /shower pan 12.51
E-mail: ¢ r1 Et ci t reak le,, c ,, p e Sef\ -%‘ CPs, c, O w. Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: PreCrerrDa( 4 nd , $ Gap Q S2!'t - c eS Water piping/DWV 56.29
Address: cr. r ( _ Other: 25.02
City /State /ZIP: Subtotal 7A_57)
57)
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 �'
�B Lic.: 1-C 8I 3 ). I I l Plumbing Lic. no.: Plan review (25% of permit fee) _.--
State surcharge (12% of permit fee) . 70
Authorized signature: . 7120 -- . / TOTAL PERMIT FEE 8 I .
Print name: 2L2 t� Z �^� Date: G_ )� _) 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.
1:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 4404616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
O
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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P 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 Thru 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
❑ 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:
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