Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013 00414
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11!18/2013
Parcel: 2S104BB13300
Jurisdiction: Tigard
Site address: 12061 SW NORTHVIEW DR
Project: Barrientos Subdivision: WALNUT CREEK Lot: 50
Project Description: Installation of residential backflow preventer for irrigation
Contractor: PREFERRED LANDSCAPE SERVICES INC Owner: BARRIENTOS,ABRAHAM N
380 NW 336TH AVE 12061 SW NORTHVIEW DR
HILLSBORO,OR 97124 TIGARD,OR 97223
PHONE: 503-764-2321 PHONE: 951-317-4371
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/18/2013 $31.27
Specifics: 1 12%State Surcharge- 11/18/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 11/18/2013 $41.23
Plumbing
Class of Work: ALT
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 an, all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is n-t started withi/ 80 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow th/ les adoptey.y the Oregon
Utility ■ = ' a ion . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You A, -, obtain a opy of the rules
or:rect questions to OUN • c- • • 5".232.1987 or 1.800.332.2344.
Issued By: /
11-e0411 / Permittee Signature: ,��/
Call 503.639.4175 by 7:00 a.m.for the next available inspection ate. irr
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 Applicat l;�.�:
Building Fixtures s roR OFFICE USE ONLY .
City of Tigard Received Permit No.:
a 13125 SW Hall Blvd.,Tigard,OR 972230 8 2013 DateBy: ft 3 -� �e�'1,2o/3- 'o'-//,/
.1114 Plan Review
: C Phone: 503.718.2439 Fax: 503.5i` tF TIGARD Date/By: Other Permit No.:
Inspection Line: 503.639.4175 p {l'// Date Ready/By: Juris: ® See Page 2 for
T I G A R U Internet: www.tigard-or.gov BUILDING DIVISIffl Notified/Method: Supplemental Information
TYPE OF WORK .FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
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(I)bath 312.70 -
Ws1-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: 1,206 1 S,W /VOt`1-7x v j ew I)e. Catch basin or area drain 18.76
�1 Drywell,leach line,or trench drain 18.76
City/State/ZIP:
T;6 (io , D 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 ! 1 31.27 3i,27
DESCRIPTION OF WORK Backwater valve 12.51
2 Clothes washer 25.02
I�r lo..' pr ei.1-er Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
a PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: l - Fixture/sewer cap 25.02�3a.rc't eo 1 ESL �p Floor drain/floor sink/hub 25.02
Address: 1 21961 5,w• miry., U 1 ef.•'• (/F:
Garbage disposal 25.02
City/State/ZIP: 7 i aorol, d‘2 Hose bib 25.02
Phone:(8613)1,1- 31 7-,-1 3 7) Fax:( ) Ice maker 12.51
14 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Pre c etreeL Z I$CQ/C Medical gas(value.$ ) Page 2
Business name: �,ti�x,�f'
Contact name: S,I.e.,,.L Roof 12.51
Roof drain(commercial) 12.51
Address: .. t0 ti„,,.. 33 6 34',ve Sink/basin/lavatory 25.02
City/State/ZIP: f;)1 Storo C,‘a q 71 z.'I Solar units(potable water) 62.54
"
Phone:(Sp3) 7 6 t/Z 32. 1 , Fax: :( ) Tub/shower/shower pan 12.51
/ Urinal 25.02
E-mail: sf evQr.e At Leas 'SCotot SL/t"Ic4S.C or.
Water closet 25.02
CONTRACTOR
� Water heater 37.52
Business name: N .n l C uio'f/St.otPC Sen.ic.(S Water piping/DWV '56.29
Address: 3gO 47( 3 36 1-'• /Lvc Other: 25.02
1f
City/State/ZIP: 115&,r,, c R 1 g 71 1 '/ _ Subtotal
Minimum permit fee: $72.50 73'D-0
Phone:($o 3 ) 7611- a 3 Z / Fax:( )
CCR-bta: LCi3- 8bt.l 3 Plumbing Lic.no.: Plan review (25%of permit fee) t
State surcharge(12%of permit fee) 1'.7
Authorized signature: TOTAL PERMIT FEE I g t ,
Print name: ST e4lt 1.0cm. Date: I'_1 h_k 3 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.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/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 •
•
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 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 $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 foithe 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
El Any new commercial building with water service 2"and• greater,except systems designed and stamped by licensed
Bath: -rub/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•orAiser.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
WaterCloset-Toilet plumbing permit can be issued.
Urinal
•
Other Fixtures: •
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