Permit 311 v CITY OF TIGARD PLUMBING PERMIT
_ • COMMUNITY DEVELOPMENT Permit#: PLM2014-00011
Date Issued: 01/14/2014
TIGARD 13125 SW Hall Blvd.. Tigard OR 97223 503 718 2439 Parcel: 2S104AD05100
Jurisdiction: Tigard
Site address: 12860 SW 129TH PL
Project: Fleskes Partition. Lot 2 Subdivision: 2004-003 PARTITION PLAT Lot: 2
Project Description: Backflow for irrigation.
Contractor: DUNCAN CLIST LANDSCAPING INC Owner: PARK PLACE INVESTMENTS LLC
2100 NW 113TH AVE PO BOX 91069
PORTLAND, OR 97229 PORTLAND, OR 97291
P
PHONE: 503-574-3111
HONE: 503-641-5948
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/14/2014 $31.27
Specifics: 1 12%State Surcharge- 01/14/2014 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 01/14/2014 $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 Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obt. a'copy of the rules
or direct questions to OUNC by calling 503 232 1987 or 1.:10-3324.
f
Issued By: �- Permittee Signature: �a
Call S .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.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE O\I 1
City of Tigard -
\NiS) Daceivyd ! /i /i Permit No. /MAYJf- „jet/r
rt 13125 SW Hall Blvd.,Tigard,012 .4 Plan Review l �s f -
• Phone: 503.718.2439 Fax: 503,5'i. .I 1 2p14 DateB Other Permit No.:rk 7r-oD 14 -402 s
TI G A R u Inspection Line: 503.639.4175 Q`v y Date ReadyBy: Jums: 0 See Page 2 for
Internet: www.tigard or.gov �wQD Notified/Method: •<„, Supplemental Information
TYPE OF WO' 1 1--
■ IL.,FL' FEE• SCHEDULE
❑New construction 141 . .
Fors .'o1 in orrtmtlfort use checklist
Description Qty. Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility comection)
CATEGORY OF CONSTRUC'T'ION SFR(1)bath 312.70
ja 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.76
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 a q<4 a s W ,Z Al Catch basin or area drain 18.76
City/State/ZIP: �'; o Drywell,leach line,or trench drain 18.76
i a 11 f Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Pmjeet name: F,t s Yst tJ Ourti k oK Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
W A VIV_1 Rain drain connector 18.76
Sanitary sewer(no.linear ft.: Page 2
Storm sewer(no.linear ft.: Page 2
Water service(no.linear It.:_J Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow premier r 31.27 3 I J.:7
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
aAcc<f k)UJ Ec 1ci ale Li Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: P44414.. l l A c ct 1Ir voS4' t«- /� Fixture/sewer cap 25.02
Address: rip, Elo 710 4 9 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: 114%9 Oft ' 72.71/ Hose bib 25.02
Phone:( ws • b (( Fax:( ) Ice maker 12.51
❑ APPLICANT Q WlTACR PIERSON Interceptor/grease trap 25.02
Business name: etC41.4 cl1 S1.L 1•utdscitik_ ram Medical gas(value:$ ) Page 2
r Primer 12.51
Contact name:
Dun cA"t C . / s Roof drain(commercial) 12.51
Address: #2 /00 A(Aj it/ Sink/basin/lavatory 25.02
City/State/ZIP: iiif ,/ • ^ 7Z•2,1 Solar units(potable water) 62.54
Phone:( � (p'4 S • Fax::(9t4) 6iiia • .4 t)a Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: 0Uytc.4.y. CCy"t.( L/s .r.61,,C_, Water piping/DWV 56.29
Address: QQ i-- ,a. 'a Other: 25.02
City/State/ZIP: ►4(,J) 00- Cr? ` Subtotal 3 1...7
Phone:(p') SCR cQ Fax:(t ) CoV Minimum permit fee: $72.50 . .5-p
CCB Lic.: 107 C z -1 S'S , Plumbing Lic.no.: Plan review (25%of permit fee) r
DState surcharge(12%of permit fee) 'e•7p Authorized signatu UII C A41 C �I TOTAL PERMIT FEE t• f 1�.p
Print name: , ` PI . Date: -1 /444 This permit application expires if s permit is not obtained with n IN days
fafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1.1BuildinglPermits\PL MU-Penn itApp.doc 10/01/09 440.4616T(I0Al2/COWWEB)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total ware Footage: Permit Fee:
Footing drain-I"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 SI69.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater S327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: , 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
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 ❑ Any new commercial building with water service 2"and
-Bath: _ 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 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
-4" ❑ 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: -LavBar 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:
1:113uildinglPemsits\PLMF_PermitApp.doc 01/04/2011 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12860 SW 129TH PL, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
2014-01-29 12:30:00
PLM2014-00011
PASS - No C of O
Violation Summary:
Inspector Contractor