Permit n CITY OF TIGARD PLUMBING PERMIT
ilIl a: COMMUNITY DEVELOPMENT Permit#: PLM2013 00331
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2013
T[G A R D Parcel: 2S 104CC00700
Jurisdiction: Tigard
Site address: 14249 SW MISTLETOE DR
Project: Nemati Subdivision: HILLSHIRE ESTATES NO.2 Lot: 112
Project Description: Installation of residential backflow preventer for irrigation
Contractor: ALL NORTHWEST BACKFLOW& IRRIGATION LLC Owner: LULUVACHI, NOUSHIN&
18334 SW FLORENDO LN NEMATI, HASSAN A
BEAVERTON, OR 97007 14249 SW MISTLETOE DR
TIGARD, OR 97223
PHONE: 503-277-3184 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/24/2013 $31.27
Specifics: 1 12%State Surcharge- 09/24/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 09/24/2013 $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
Utility Notifi --•ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire •uestions to OU • by callin• 503.232.1987 or 1.800.332.2344.
Iss ed By: , '�� Permittee Signature: a��L''111, �41 4 �1
J
Call 503.639.4175 by 7:00 a.m.for the next available inspec 1:1
•te.
This permit card shall be kept in a conspicuous place on the job site until tion of the project
Approved plans are required on the job site at the time of each ction.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
9
111 City of Tigard Date/By: / i i �M Permit No.: °ZiVe/3j-G033
a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/13y: lung: ® 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 checklist.
Descri.lion • . Ea. Total
4 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath 312.70
❑ I-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: -- \ u�- ` ��S v.� - c-Q-_ - Catch basin or area drain - 18.76
City/State/ZIP: ----cm)7p 1 (��J \`� \ Drywell,leach line,or trench drain 18.76
��Vl ,c \J`, .f G eE Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: C Hr4-7-1 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:
fax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�y Clothes washer 25.02
2K)/:_\,' u \) ` �� ,/ Dishwasher 25.02
_ Mil 1 S I '' Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: \N,1�-
Fixture/sewer cap 25.02
T n Floor drain/floor sitdc/hub 25.02
Address: \U 3 . Q S 'n\>"--.\- - -----\-10 c - Garbage disposal 25.02
City/State/ZIP: �%1 D . Z:{J Hose bib 25.02
Phone.*' ) _ _ Fax:( ) Ice maker 12.51 '
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap ■ 25.02
Business name: ( \ Medical gas(value:$ ) Page 2
1 ��\ �' L I_ lAuIP•\ * Primer 12.51
Contact name: 0.1! ♦ Roof drain(commercial) 12.51
Address: +u L- S\%3 \r q� ,^ Lc fLe£,sno Sink/basin/lavatory 25.02
City/State/ZIP: . 1� ._. ,`, '' •i, Solar units(potable water) 62.54 -
Phone: 7100,,. _ In Fax: :( ) Tub/shower/shower pan 12.51
E-mail: -/� `1,oivti'�<T' yQh��1>�+Ct,c�r,'��C, Urinal 25.02
iT \ V��CONTTRRACTTO,R �IT�l ! � Water closet 25.02
Water heater 37.52 •
Business name: ,t\\ n M Water piping/DW V 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
•Lic.: °1Okf\ //i/y Plumbing Lic.no.: Plan review (25%of permit fee)
II State surcharge(12%of permit fee)
Authorized sig a re: TOTAL PERMIT FEE au
�f.
Print n. ,,..�.' A .\ ^ D This permit application expires if a permit is not obtained within 180 days
1 1 ylY�\ z after it has been accepted as complete.
ay I \
I:\ *Fee methodology set by Tn-County Building Industry Service Board.
Building�Pe -PermitApp.doc 10/01/09 q 0-4616T(10/0?JCOM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fce Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain- 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 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 0T 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
-Jacuzzi/Whirlpool engineer.
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 a_s_ defined in'OAR918-780-0040.
Drinking Fountain % `
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" r s Isomefric'iir'Riser Diagram
4" ❑ Isometric or riserdiagram 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 Filler increase of sewer EDUs,a sewer permit will beissued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
WaterCloset-Toilet plumbing permit can be issued.
Urinal .
Other Fixtures: '
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