Permit CITY OF TIGARD PLUMBING PERMIT
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!PI COMMUNITY DEVELOPMENT Permit#: PLM2014-00250
13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 07/30/2014
TIGARD Parcel: 2S108AB04900
Jurisdiction: Tigard
Site address: 14005 SW 155TH TER
Project: Brentwood Estates. Lot 11 Subdivision: BRENTWOOD ESTATES Lot: 12
Project Description: Installation of residential backflow preventer for irrigation
Contractor: MERTEN AND SON'S LANDSCAPE Owner: BRENTWOOD HOMES
PO BOX 261 17500 SW CAESAR TERRACE
SAINT PAUL, OR 97137 TIGARD. OR 97224
PHONE 503-209-5159
PHONE: 503-407-1101
FAX
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/30/2014 $31.27
Specifics; 1 12%State Surcharge- 07/30/2014 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 07/30/2014 $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 obtain a copy of the rules
or direct qu to-OUN/C by calling 503 232.1987 or 1.800.332.2344.
Issue By: \� //r t_L /' Permittee Signature: , 04111
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.
Plumbing Permit Applicsa�t��[1ED
Building Fixtures 11�'
1711 City of Tigard �i�� 3 0 2014 Received -7 3c//y y� Permit -r!4/-4...c2
u DateB ( - �
13125 SW Hall Blvd.,Tigard,OR 4963
Plan Review u
Phone: 503.718.2439 Fax: 501598.1960 Date/By: Other Permit No.: / f (9 /*3-a0/e7
TIGARD
Inspection Line: 503.639.4175C'I I OFTIGARD DateReady/By: m.+Y B! See Page 2for
J
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE tr '«r �`r a '
' FEE* SCHEDULE
-New construction ❑Demolition For special information 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(1)bath 312.70
14I-and 2-family dwelling ❑Coercia�ndustrial SFR(2)bath 437.78
mm
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: f yI'V`t S(y s“�,� jri �� Catch basin or area drain 18.76
'�Vt T`'' Drywell,leach line,or trench drain 18.76
City/State/ZIP: /t c Q^-� .
,� �'` ! !Z�3 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 fl.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear it.: ) Page 2
Subdivision: I Lot no.:ti Fixture or item:
Tax map/parcel no.:
Backflow preventer I 31.27
DESCRIPTION OF WORK Backwater valve 12.51 , -
(9-4.L./0(/ ( Clothes washer 25.02
rr►3 4)'ie-i `S)O co./ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
-
❑ PROPERTY OWNER I ❑ 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 1251
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:S ) Page 2 Business name: i"'r r i s +.4. J C L Primer 1251
Contact name: cJ Ai!
Roof drain(commercial) 12.51
Address: Po 66d t 6 i Sink/basin/lavatory 25.02
City/State/ZIP: Si_ Q_N I Gr 97 &I Solar units(potable water) 62.54
Phone:( C
) '9 am►crll_ ,..5)`5 y f Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
-- / Water heater 37.52
Business name:/ I coil 1 Water piping/DWV 56.29
Address: yo Go,7- Z 61 Other: 25.02
City/State/ZIP: s'•1-y 9.44 t G( 9 ) 6 `l Subtotal
Phone:(541 ) 70"? 51 is i Fax:( ) Minimum pennit fee: $72.50 7;'‘-;-6
Plan review (25%of permit fee)
CCH-L-icr Lets - it Tit Plumbing Lie.no.: State surcharge(12%ofpermit fee) -
Authorized signature: TOTAL PERMIT FEE lip, ?')
�v w l a,"',�+•)01,0* 7 f M�� This permit application expires if a permit is not obtained within 180 days
Print name: L3>s Date: after it has been accepted as complete.
!ll���""'
'Fee methodology set by Tri-County Building Industry Service Board.
1.1 Building/Permits1PLMU-PermitApp.doc 10/01/09 440-4616T(10100/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities - tee(es) Totsi Square Footage: Permit Fee:
Footing drain-1 a 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 5233.20
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
Valuation: Permit]Petri
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 Qtr. 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/h r 525,001.00 to 550,000.00 $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 550,000.00.
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
Quantly by Fixture Type Plan review is required for any of the following.
Fixture Type for Repine/ Please check all that apply.
Work Performed: C rpped 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 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"
Isometric or Riser 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: -Lay/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: lithe 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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:1 Building\Permits\PLMF_PermitApp.doc 08/04/2011