Permit CITY OF TIGARD PLUMBING PERMIT
111 • COMMUNITY DEVELOPMENT Permit#: PLM2014-00269
G A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/13/2014
Ti
Parcel: 2S 109AD03100
Jurisdiction: Tigard
Site address: 14605 SW 130TH AVE
Project: White Subdivision: WOODFORD ESTATES Lot: 23
Project Description: Installation of residential backflow preventer for irrigation system and connect property drainage to storm drain.
Contractor: OWNER Owner: WHITE, RANDALL&ANN-JEANNETTE
RANDY WHITE 14605 SW 130TH AVE
14605 SW 130TH AVE TIGARD,OR 97224
TIGARD, OR 97224
PHONE:
PHONE: 503-784-0053
FAX:
FEES
Quantity Description Date Amount
6 If Storm and Rain Drain 08/13/2014 $62.54
Specifics:, 1 ea Backflow Preventer 08/13/2014 $31.27
1 12%State Surcharge- 08/13/2014 $11.26
Type of Use: SF Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $105.07
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. • r NC by calli i• 503.232.1987 or 1.800.332.2344.
Issu=• By: +111111 Permittee Signature:
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 Apolie CEIVEI)
Building Fixtures I�+
City of Tigard 2014 Received 13 f Permit No.: j 1-1 -eY��o9
1111 • 13125 SW Hall Blvd.,Tigard,OR 9 1 3 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T t G I:n Inspection Line: 503.639.4175 Cl TV OF TIGNRIJ Date ReadyBy. furls El See Page 2 for
Internet: www.tigard-or.gov Notifed/Method: l Supplemental Information
FEE*, 1DLE
❑New construction ❑Demolition For special information use checkl&
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
............:.:
SFR(1)b nth 312.70
®1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 50032
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other: Fire sprinkler l-sq.ft.) Page 2
JOB SITE INIPO AnO1tI AND LOCATION Site utilities:
Job site address:14605 SW 130th Ave Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 leach line,or trench drain 18.76
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:130"Ave and Birdsview Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_J Page 2
Storm sewer(no.linear ft.:6) Page 2 62.54
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer x 31.27 31.27
11� 'f'fE)!1!.E:il `:�Wt 0.(.: ; .
Backwater valve 12.51
•:::. . Clothes washer 25.02
Install Backflow preventation device
Dishwasher 25.02
Connect property drainage(after grading)to storm drain Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
Name:Randy White Fixture/sewer cap 25.02
Address:14605 SW 130a Ave Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:(503)784-0053 Fax:( ) Ice maker 12.51
Interceptor/grease
P >��
ap 25.02
02
Business name:
Medical value:S ) Page 2
Primer 12.51
Contact name:Randy White Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) I Fax:•( ) Tub/shower/shower pan 12.51
E-mail:raadyjwhite®gmail.com Urinal 25.02
;: Water closet 25.02
•'. %• •:.x.::: ::::: : ::::::::: :::: is ::::
::; rd...........+ ..:::::::::•::,.::::::::.:::: Water heater 37.52
Business name: 0/0 G,Ea- Water i in W V 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 93.81
Plan review (25%of permit fee) -.2345--
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) 11.26
Authorized signattrrey 111/1 TOTAL PERMIT FEE I -1.28-51--
Print name: IL . ' I Date'.a. This permit application r it expires if has a permit is not obtained within 180 days
accepted as com r c"?
P)5.
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
::::: .. . .
a t.Fee
Footing drain-_:es 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 $23120
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 Y
Storm&Rain Drain-1st 100' 1 62.54 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
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*.
'Quantity by Fixtige Type
Fixture Type for f
Work PerfasxMld Caper i Added Rrrloeata :: Plan review is required for any of the following.
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 Thru ❑ 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"
Car Wash Drain '#l`#111'Ilr
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Iav -Non-food related
-Bradley
-Commercial-food related _
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: