Permit CITY OF TIGARD
111111
COMMUNITY DEVELOPMENT PLUMBING PERMIT
t#:
PLM2014-00391
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/03/2014
Parcel: 2S 110DD06600
Jurisdiction: Tigard
Site address: 10650 SW SUMMERFIELD DR
Project: Summerfield Civic Association Subdivision: WILLOW-BROOK-FARM Lot: F
Project Description: Installation of reduced pressure backflow assembly for the irrigation system.
Contractor: WILLAMETTE LANDSCAPE SERVICES, INC. Owner: SUMMERFIELD CIVIC ASSN
18480 SW PACIFIC DR 10650 SW SUMMERFIELD DR
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503-625-9600 PHONE:
FAX: 503-625-9714
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/03/2014 $31.27
Specifics: 1 12%State Surcharge- 12/03/2014 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 12/03/2014 $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
Utilit •. i Ica i. enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or.erect questions to • NC by calling 503.232.1987 or 1.800.332.2344.
I.sued By: / Permittee Signature: `
l //V(L?A/�l
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 ApnligE rvEP
Building Fixtures l 1v G FOR OFFICE USE ONLI `
City of Tigard r�^ 2014
/p /1 Permit No.: /`NQ�/�[+�39/
• 13125 SW Hall Blvd.,Tigard, 09223 rri 77 L
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 u 1
Date/By: Other Permit No.:
Inspection Line: 503.639.41V 1TY OF 1 I(,ARD Date Read B kris BI See Page 2 for
TIGARD Ready/By: S
Internet: www.tigard or.mi,"rs *n r, O Notified/Method: Supplemental Information
1 1 1'1 UI 11(Mk FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
XAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling 4 Comercial/industrial SFR(2)bath 437.78
m
SFR(3)bath 500.32
❑Accessory building 0 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: lG650 So ryts1Mws[f},ct`Q Catch basin or area drain 18.76
1'Y V(_
City/State/ZIP: Ti. Q� !°Off.19V\ / ��da*I Footing leach line,or trench drain 18.76
S ! 1 n Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Sti"ixiCJ4;(0, C AA.L kccOLtCC4i0►At Manufactured home utilities 50.03
Cross street/directions to job site: -OP Clkb 1wA--sc. (S, w((A f 46e Manholes 18.76
rA t�5 St..w,wLe,/ t;0 fX OtiVL 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 i 31.27 51- P7
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
(IASt oat A:1%W% O e^ Li<dot cck vve;,AV'C. VI f1 C iA�I - Dishwasher 25.02
.4-SS e t,w�1%.( Lav k'1w.... (si 1�`Set 4.'CnN! 3t(S4 GV`'1• Drinking fountain 25.02
t Ejectors/sump 25.02
❑ PROPERTY OWNER , ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:SktAoWCj f is (408... „cam G
p1'G�.kl'O,,'l Floor drain/floor sink/hub 25.02
Address: (0650 S' ) 5t4 vAtxttv.(,(leA� 0 I:Vt. Garbage disposal 25.02
City/State/ZIP: '''‘: 4,4 I a(.es I 1aat Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT , CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ ) Page 2
Contact name: . Primer 12.51
�Z(t tA N vG` ( Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: L,,),1\Gr„ytc ( („<,,,.Z.,..,,,c, v Ac.t 1 i s L Waterpiping/DWV 56.29
Address: «'t -- S,..) Nit,:i J4 d,;4.,_ Other: 25.02
City/State/ZIP: \t,�q_\a.t,,'�l f QV(fjo 141?0 6 a Subtotal 31 .17
Phone:(Sy;) ‘,4,5* V a,5" - c r o Fax:(co ) e S 01 7 /LI Minimum permit fee: $72.50 7a SO
Plan review (25%of permit fee) .1.1r...-4-4-'
CCB Lic.:Lcg'14 oCI ii ii e,.. Plumbing Lic.no.: State surcharge(12%of permit fee) $. 70
Authorized signature:�!i / -t!/Z _ TOTAL PERMIT FEE r$.�J
This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete.
Print name: jt'.cf�e. Sk e ,-" t A I Date: la) *Fee methodology set by Tri-County Building Industry Se Board.
[:1Building\Permits\PLAtIl-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 8I .1
1
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- I" 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
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 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
p 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 Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower CI 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 El New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial El 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.
-4" Isometric or Riser Diagram
Car Wash Drain
El Isometric or riser diagram is required for new buildings-Domestic-non-food s
g q g
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/Lav -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:
C:\Users\jesse\Downloads\PLMF-PermitApp(1).doc 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10650 SW SUMMERFIELD DR, TIGARD, OR,
97224
Commercial - Plumbing
399 Plumbing final
FAIL
PLM2014-00391
George Heimos
1. Provide electric power with heating device or provide a way to remove water from RP
and water piping in frost area. 313.5
2. Cannot imbed water pipes in concrete, either wrap pipes or provide sleeves. 313.1
3. Recall inspection when completed.
4. If backflow disconnected from piping, retest required. 603.3.2/603.1
NOTE: Backflow test results provided: 2" Febco model 860 serial no. H22083
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10650 SW SUMMERFIELD DR, TIGARD, OR,
97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00391
George Heimos
Jstegman@willamettelandscape.com
Violation Summary:
Inspector Contractor