Permit CITY OF TIGARD PLUMBING PERMIT
1 1 11- 2 - COMMUNITY DEVELOPMENT Permit #: PLM2013 -00249
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2013
Parcel: 1S133CA09100
Jurisdiction: Tigard
Site address: 13676 SW ROSEMARY LN
Project: Village at Summer Creek, Lot 14 Subdivision: VILLAGE AT SUMMER CREEK Lot: 14
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)
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.
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Issued By: / Permittee Signature: O',) /9 fet5L-7-719 �
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.4
Plumbin>� Permit Application �
Site Utilities 1a OFFICE l ONLY ��
REGE V .� FOR
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Received ,: ,
City of Tigard Date /By: 7 0 /3 PORNO /70�0/3 �Qd y •
• 13125 SW Hall Blvd., Tigard, OR 9 722L 2 2 2013 Plan Review �
Phone: 503.718.2439 Fax: 503.598. q D Other Permit No ST�O /a'l. eo '
Inspection Line: 503.639.4175 Date R ,g r s ® See Page 2 for
7 LGnxll Internet: www.tigard- or.gov CITYOFT Notified/Method: / o Supplemental Information
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TYPE OF UI UI DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checkUsa
Description I Qty I Ea I Total 1
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ I- and 2- family dwelling Commercial/industrial SFR (2) bath 437.78 Commercial/industrial
SFR (3) bath 500.32 l
❑ Accessory building 0 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: I b S VII 1c_ 05e_nr- 61,i (....-V1 VV ( Catch basin or area drain 18.76
Gi Drywell. leach line, or trench drain 18.76
City /State/ZIP: -T-L.0 O Vd- iL _ {'3 029,3 Footing drain (no. linear ft.: _) Page 2
Suite bldg. /apt. no.: v Project name: L 3L)mm& r C. .< Manufactured home utilities 50.03
Cross street/directions to job site: 5 (, • 30 {2-t S\ l.) Manholes 18.76
S leA (D GlYrnW 5 �-Q. Rain drain connector 18.76
l� Sanitary sewer (no. linear ft.: _J Page 2
Storm sewer (no. linear ft: _.) Page 2 '
Water service (no. linear ft.: ) Page 2
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Subdivision: Su r- e . - Cye-GV. Lot no.: L 4 Fixture or item:
Tax map /parcel no.: Backftow preventer 31.27
DESCRIPTION OF WORK Backwater valve ' 12.51 101. CJ i
Clothes washer 25.02
` Ty \ sq"c-t/ �2Y) Y, c\ e- Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02 .
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ 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
Water heater 37.52 •
Business name: A ) i a vie yo-I Lg fi& C5 cti e Water piping/DWV 56.29
Address: p C , B i s 0 Other. 25.02
CityvStatefZ P: W 008. 'IIJYVA C. CLI 1 Subtotal ` v, r 1
Phone: (S.1) 3) q I ... (2, 31 Fax: (531 7 I - I D.h a Minimum permit fee: $72.50 7a r50
CCB Lic.: 7/ Pi •ingLic. no.: Plan review (25 % of permit fee) ------ / State surcharge (12% of permit fee) 55 5.01
Authorized signature TOTAL PERMIT FEE
Print name: 'J '_% D a1e: 4 1 1 1 6 1 1 `� This permit application expires if a permit is not obtained within 18p days r
t 1 after it has been accepted as complete.
•Fee methodology set by Tri- County Building Industry Service Board.
1:1BuildingTermiis\PLNIU- PermitApp dos IW01/09 440- 4616T(1W e ,,,_, � O
Jul 19 13 09:49p Ashland Brothers 503 - 981 -1058 p.5
1
Plumbing Permit Application - City of Tigard 1
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l' 100' 50.03 0 to 2.000 $ 121.90
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Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7200 $233.20
Sewer - 1st 100' 62.54 7.201 and greater $327.54 i
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 $7250
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the fist $5,000.00 and $152 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P and includine $10,000.00.
Inspection of existing plumbing or for SI 0,001.00 to 125,000.00 $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 * .
Quand y by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive That ❑ 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 OAR918 780 - 0040. •
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
- 3"
Isometric or Riser Diagram
Car Drain El Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal - Domestic -food related that meet the qualifications above.
-Commercial -food related
- Industrial -food related
Ice Mach.IRefrig. Drains
- Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non -food related
- Bradley
- Commercial- food related
- Service
Swimming Pool Filler *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://w vvw.tigard-or.gov/city_hallidepartments/cd/does/PLMU-PennitApkdoc
IYGARD
City of Tigard
October 15, 2013
Ashland Brothers Landscape
Attn: Thomas N Ashland
PO Box 130
Woodburn, OR 97071
Re: Permit No. PLM2013-00249
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13676 SW Rosemary Ln
Project Name: Village at Summer Creek,Lot 14
Job No.:
Refund Method: n Check # in the amount of$ •
® Credit card "return" receipt in the amount of$64.96.
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit" receipt in the amount of$
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,
,c19,
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
City of Tigard
Accela Refund Request
'TMARI q
:'::e= r=;:;ter®
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Pow/IL/lc/ion 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
\Voodburn, OR 97071
TRANSACTION INFORMATION:
Receipt #: 192361 Case #: PLI\12013-00249
Date: 7/23/2013 Address/Parcel: 13676 SW Rosemary Ln
Pay Method: CreditCard Project Name: Village at Summer Creek Lot 14
EXPLANATION: Per applicant's request as no irrigation on it,its 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%o State Surcharge 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIGNA P S D TE:
If under$3,000 Professional Staff �'
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If under S 12,500 Division Manager
If under S25,500 Department Manager
If under 550,000 City Manager
If over$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: h//S//3 By: i��-747
I:\Bulding\Rclunds\RcfundReyuc>t.d.,c>i 9/Ill/20111
Aug 20 13 08:16p Ashland Brothers 503-981-1058 �(j
RECVED. iVEu
! „ City of Tigard O COMMUNITY DEVELOPMENT DEPARTMENT AUG 2 0 2013 J,
,:.'0, = Request Permit Action CITY OFTIGARD
BUILDING DIUISIOr
T ', Alt ), 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www,tigarct-or ov ;1
TO: CITY OF TIGARD V 0 1 D i
Building�Division Services Supervisor
13125 SW Hall Blvd.,Tigard,OR 97223 /6//5//5 4
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name: /J ji
INVOICE TO: (Business or individual) 1.5J1 l,fwel 1 t1 -I/Ke v5 `� 5„!,.11^4.-.,C-
Mailing Address: 17..! o • ?jc,k I -t;
City/State/Zip: UjOt,Y{If)Vic 0 (Y1I- 6/ , ;::71
Phone No.: �✓ 3 4'G'( 17 1 31
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
® 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/REPI _ • "I'_- • t •t. ERMIT(do not cancel permit).
Permit#: Pal o20 . • __ .T•• y- (1
Site Address or Parcel#: , 3 (^. -1 5 (,v i c_u s�,y y.l��vt 1 A,i T -1 -1 CYZ _ Ci 7",,,2,..?, 3
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Project Name: ( .elA•4-(--
Subdivision Name: CA%1'11 ll It f CVe v'. Lot#: V?
EXPLANATION: iv e.6 (e. iel ('f/t e_.c:,ll� ,,e,cc,u j 11 r_1
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l'b 1 `j, -1--i�:�i .7 bin H+ 11 ...) Cn r el Ii'l ri!�(:yi) I y' y 1 / - ,
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Signature: '� -.T/',✓->v. � `— Date: 8/ u j 13
Print Name: (72;::_-_71-6724) /=--.7._<-3 .-P 72% -9
Refund Policy
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1. 'I'lw Director or Building Official may authorize the refund of
a) any ice 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 13()%of the land use application fee for issued permits.
d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80%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.
FO�tOF ICEtiSEO L :
Rte to Sys Adman: Date By Rte to Bldg Admin: Date
Refund Processed: Datej)�/s/ 3 By - Invoice Processed: Date By
Permit Canceled: Date/ lie 3 By 4 -. Parcel Tag Added: Date By
Receipt# Date Method Amount$
I:\Butt.ling\Forms\Req PermitAction.doc Rev 05/25/2012