Permit CITY OF TIGARD PLUMBING PERMIT
11 / 11 1- 0 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00248
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2013
Parcel: 1S133CA09000
Jurisdiction: Tigard
Site address: 13664 SW ROSEMARY LN
Project: Village at Summer Creek, Lot 13 Subdivision: VILLAGE AT SUMMER CREEK Lot: 13
Project Description: Irrigation backflow device.
Contractor: ASHLAND BROTHERS LANDSCAPES Owner: CENTEX HOMES
2153 MOLALLA HIGHWAY 11241 SLATER AVE NE STE 100
WOODBURN, OR 97071 KIRKLAND, WA 98033
PHONE: 503 - 981 -6131 PHONE:
FAX: 503 - 981 -1058
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/23/2013 $31.27
Specifics: 1 12% State Surcharge - 07/23/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 07/23/2013 $41.23
Class of Work: OTR
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
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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 in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: D `, /97 e, 2-770, 11
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.
Jul 19 13 09:48p Ashland Brothers 503 - 981 -1058 p.1
i
Plumbing Permit Applic•¢`i�`•
ly
Site Utilities •• r -c)lt l)rrlc 1: [sr. oNlA i
• l 2 2 2013 Received / 7e /3 . 0 _go ay.' • City of Tigard Permit No,"
13125 SW Hall Blvd.. Tigard, OR Plan Revue
i m Phone
503.718.2439 Fax: 5 ., Date/By: Other Permit N 9 ^ 1JTa o is - DOa 9 " ,
• 1 I G n l D Inspection Line: 503.639.4175 It TIGARD Date Ready/By: 1 See fo
Internet www.tigardor.gov BUILD 61 Supplemental 2 ta form ation
BUG DIVISION Notified/Method 11, SCHEDULE
TYPE OF WORK FEE
❑ New construction ❑ Demolition For special rnforrrrmon use checklist. •
Description I Qty. I Ea- I Total
❑ Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1 -and 2- family dwelling ❑Commercial/industrial
SFR (2) bath 437.78
SFR (3) bath 501132
❑ Accessory building ❑ Multi- family li
Each additional bathikitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. it) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: i3 (96 5w i -ma, C� 17_4 Catch basin or area drain 18.76 ,
Drywall, leach line, or trench drain _ 18.76 - •
City/State/ZIP: �G a v _ (XL" q �. 4
u c � l Footing drain (no. linear .: ) Page 2 ;
Suite/bldg. /apt. no.: Project name: Jorr1mQy l_ 1/�_I� Manufactured home utilities 50.03
street/directions to job site:
Cross s - 30 - <t /j a Manholes 18.76 •
{. - Y Rain drain connector 18.76
Sanitary sewer (lm. linear ft.: ) Page 2
Storm sewer (no. linear ft.: - ) Page 2
Water service (no. linear ft: ) Page 2
Subdivision: �t 1 m -. 2X CY P� K Lot no.: I3 _Fixture or item:
Tax map /parcel no.: Backflow preventer 111 31.27
- DESCRIPTION OF WORK Backwater valve 12.51 `a,
Clothes washer 25.02
J-- S ..,a-- - "7 A. ) el Dishwasher 25.02
Drinking fountain 25.02 1
Ejectors/sump 25.02 ",
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02 r
Floor drain/floor sink/hub 25.02 I
Address:
Garbage disposal r
25.02
City/ State/ZIP: Hose bib t 25.02
Phone: ( ) Fax: ( ) Ice maker 12.5]
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ _ ) Page 2
Primer 12.51
Contact name: 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: Urinal 25.02
CONTRACTOR
Water closet 25.02
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Water heater 37.52
Business name: /45)h I aria Ell-A-1-20_,S Le'1.45C Water piping/DWV 56.29
Address: p o , jj nk j 3 b Other: 25.02
City/State/ZIP: I pu �1 y C5 '(.9--ClqI - Subtotal . I
Phone: (C 7 e' r List Fax: (576) 9 61 - 1058 Minimum permit fee: $7250 2 , Sa
Plan review (25
CCB Lic.: 12 i 7-y Plumbi _ Lic. no (25% ofpermit fee) 1-
State surcharge (12% of permit fee) V 5. Ul
Authorized signature: _ /.._...,:...-# L- -� TOTAL PERMIT FEE i
J { r r I This permit application expires it a permit is not obtained within 180 days
Print name: Date: I ha
after it s been accepted as complete - /
uService •Fee methodology set by Tri- County Budding Industry Service Board. / _ ✓
I \ aulding ,Pe:min`PLA1U- PermnAnn.drx 10/0109 440.46loT(10/07JCOM/WEBS et. �/Ol°�O/)
Jul 19 13 09:48p Ashland Brothers 503- 981 -1058 p.2
Plumbin &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
c
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 5 1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 55,001.00 to 510,000.00 $72.50 for the first S5,000.00 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 $14850 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:
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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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Figure Type for Replace/ Plan review is required for any of the following. Performed: Capped Added Relocate q y ow &
Baptistry /Font Please check all that apply.
at1r Tub /Shower ❑ Any' new commercial building with water service 2" and f
lacum/Whirlpool - greater, except systems designed and stamped by licensed t
Car Wash -Each Stall engineer.
- Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor /Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR9 I 8-780-0040.
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Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3'
Isometric or Riser Diagram .
Car Wash Drain
Garbage - Domestic - non - food ❑ Csometric or riser diagram is required for new buildings
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice'vlachdRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
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Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non -food related
- Bradley
-Commercial- food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http: // www.tigard- or.gov/ city_ hallidepartments /cdldocs/PLMU- PcemitAp2dot
TiOARD
City of Tigard
October 15, 2013
Ashland Brothers Landscape
Attn: Thomas N Ashland
PO Box 130
Woodburn, OR 97071
Re: Permit No. PLM2013-00248
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13664 SW Rosemary Ln
Project Name: Village at Summer Creek,Lot 13
Job No.:
Refund Method: ❑ Check # in the amount of
® Credit card "return" receipt in the amount of$64.96.
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
n Trust account "deposit" receipt in the amount of$
Comment(s): Per applicant's request as "no irrigation on it, it's a common irrigation".
Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
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��T
City of Tigard
_TA Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for PelmitAitioi form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Ashland Brothers Landscape DATE: 10/15/2013
.Attn: Thomas N Ashland
PO Box 130 REQUESTED BY: Dianna Howse
Woodburn, OR 97071
TRANSACTION INFORMATION:
Receipt #: 192360 Case #: PLM2013-00248
Date: 7/23/2013 Address/Parcel: 1366.1 SW Roemary Ln
Pay Method: CreditCard Project Name: Village at Summer Creek Lot 13
EXPLANATION: Per applicant's request as "no irrigation on it,it's a common irrigation". Refund 80% of
permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plumbing permit 230-0000-43101 $58.00
12%u State Surcharge 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIGNAT ' _S DATE:
If under$5,000 I/000 Professional Staff ( /- o-
If under$12,500 Division Manager
If under 525,500 Department Manager
If under$50,000 Ciry Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: /e/AS//3 By:
I:\Ruldin;\Refunds\RefundRcyucsc.doc x 09/01/2UIll
Aug 20 13 08:17p Ashland Brothers 503-981-1058 RECEVEDCe/
'''` City of Tigard ® COMMUNITY DEVELOPMENT DEPARTMENT AUG 2 0 2013
. ,, <:;.
Request Permit Action CITY OFTIGARD q BUILDNG DIVISION
TJGARJ,,,• 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • \',%ww.tigttr -nr.ao
TO: CITY OF TIGARD
I D
Building Division Services Supervisor V
13125 SW Hall Blvd.,Tigard,OR 97223 id A9,,, /�
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner `[.'Applicant ❑ Contractor ❑ City Staff .,
(check one)
REFUND OR Name: ,.
INVOICE TO: (Business or Individual) [ \0,1vA
Y \ vc ���.c ( i pQ`'� l>
Mailing Address: .p.C, . f%r-, `2\(')
City/State/Zip: jJ OIUL\9L'►. f' CAL C , -1
Phone No.: --P3 - ((0 j - ,13 1
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
a2...
'-CANCEI./VOID PERMIT APPLICATION.
c] REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
/� INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/' ' -_ INIRAC"'• t ON PERMIT(do not cancel permit).
Permit#: 'tiloZ0 1 5 -_ 00,E
Site Address or.Parcel #: 13 k;;r 6 4 UV N O`:rte,y'1r; ti t,�,0 l N -("\sr- d' 011. I.-/-t;
Project Name: e cX
Subdivision Name: 11 r,14, v- ( v N e k_ Lot#:
EXPLANATION: 'weec1 v?,t,0 CI, C-.i,ty+.. \A, �i,�C'-C c�,,; t`... v\ ;
i 1 y t c G,-\-:,L, t. e clA `' 0, i .. "�
�� r ..„.Signature: d f f i /
Print Name: p(..::::::3"--7- C c ;a/7-77)9-
Refund Polio'
I. The Director or Building Official may authorize the refund of: •
a) any fee which was erroneously paid or collected.
b) not more than 80°%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80%of the land use application fee for issued permits. .,
d) not more than 80°.-ii of the building plan review fee when an application is canceled before any plan review effort has been expended. .
ej not more than 80"-0 of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2-4 weeks for processing refunds. .
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.
Rte to Sys.Admire: Dare By Rte to Bld Admin: Date %v®® B' 4.i��
Refund Processed: Date/dAfNan Bv_j L- Invoice Processed: Date By
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Permit Canceled: Date , All Bs' . Parcel'1'a Added: Dare By
EMEIRMIIIMI Dare Method Amount$
I:\Building\Itorms\RcyPemiit'\ction.Joc Rev 115/25/2012
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