Permit CITY OF TIGARD PLUMBING PERMIT
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3' COMMUNITY DEVELOPMENT Permit#: PLM2015-00328
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2015
Parcel: 1 S135BB00800
Jurisdiction: Tigard
Site address: 10645 SW GREENBURG RD
Project: IFLY Subdivision: HILLSBORO Lot: PTS 1-2
Project Description: Backflow preventer for irrigation system
Contractor: JS CUSTOM LANDSCAPING INC Owner: EWING IRRIGATION PRODUCTS INC
PO BOX 65368 3441 E HARBOUR DR
VANCOUVER,WA 98665 PHEONIX,AZ 85034
PHONE: 360-721-2447 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/29/2015 $31.27
Specifics: 1 12%State Surcharge- 09/29/2015 $8.70
Plumbing
Type of Use COM 41 ea Minimum Fee Adjustment- 09/29/2015 $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 • o : OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu By: (I /+r 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.
0912812015 17:24 J's Custom Landscaping,Inc. (FAX)3605462063 P.001
Plumbing Permit Applica' CE!V 1'P
Site Utilities 1(11: t)► 1 I< I ► •I (i.l
14...... City of Tigard S F P 2 8 2015 Received `��9 is Permitbio• 12 1//6/5-71273,25?
• 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
I• Phone: 503318.2439 Fax: �j} Date/a: Other Permit No.:
Inspection Line: 503.639.4175 11 y r 1ll,Altll
1 1\,,∎t;I> Date Ready/By: kris: 0 See Page 2 for
Intvmet: www.tigard-or.8oV r I( lii�j 1a n�V��l\/i'op, hotified/Method -
Supplemental Information
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TYPE OF WORK FEE' SCHEDULE
®New construction I ❑Demolition For special btformation use checklist
Description I Qty. 1 Ea.
❑Addition/alteration/replacement i ❑Other: New 1-2-famil dwellinl- includes 100 ft.for each utility connection
CATEGORY OF CONSTRUCTION t
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family t Each additional bath/kitchen 25.02
❑Master builder �❑Other; Fire sprinkler( sq.ft.) Page 2
l LYE,,i'. JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin Job site address:111695 SW Greenburg Road ' ' "drain 18.76
Dtywell,leach line,or trench diain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no,: I Project name:iFly-Tigard 50.03
Cross street/directions to job site:Take the Beaverton-Tigard Highway Exit 5 Manholes 18.76
Go South Rain drain connector
First righthand turn,to the west - '
linear Storm sewer(no.linear ft.: ) Page 2
Water service(no.
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.:15135131300800 Backflow
Backwater valve I 2.51
DESCRIPTION OF WORK
Clothes washer 25.02
Installation of one(1)backflow preventer to be used for landscape irrigation Dishwasher 25.02
Drinking fountain 25.02
•
I Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12-51
Name:SkYgroup Investments,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:6034 West Courtyard Drive,Ste.135 Garbage disposal 25.02
City/State/ZIP:Austin,TX 78730 Hose bib _ 25.02
Phone:(206)979-4359 Fax;( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON ' Interceptor/grease imp 25.02
Business name:Js Custom Landscaping Medical gas(value.$ ) Page 2
Primer 12,51
Contact name:James Marsh - ..
Roof drain(commercial) 12.51
Address:6416 NE 109i1'St Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA,98686 Solar units(potable water) 62.54
Phone:(360)7212447 Fax::( ) 'Pub/shower/shower pan 12.51
E-mail:James @jscustomlandscaping.com Ldnnl 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Js Custom Landscaping Water t?/
i to DWV 56.29
.. P p
Address:6416 NE 109th St Other: 25.02
City/State/ZIP:Vancouver,WA,98686 Subtotal 31.27
Phone:(360)721-2447 Fax:( ) Minimum pcnnit fee: 572.50 72.50
CCB Lie.:8806 Z. .pep Plumbing Lic.no.: Plan review (25%of permit fee) I T9r
State surcharge(12%of permit fee) ' 8.70
Authorized signature: �j� nab,
A TOTAL PERMIT FEE f'
rPrint name: Date: This permit application expires if a permit is eat obtained within 180 days
after it has been accepted u complete.
'Fee methodology set by Tri-County Building Industry service Bp
1:U4uildina\PcmratsIPLMU-Permit App,dnc 1(1/01/09 440-4 el 67(1 aa02/COM/wea) Cg'
09/2812015 17:24 J's Custom Landscaping,Inc. (FAX)3605462063 P.002
Plumbint Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
1 Site Utilities Qty. Fee(es) T"t Square Footage: Permit Fee:
Footing drain-I"100' 50.03 0 to 2,000 5121.90
Footing drain-each additional 100' 37.52 2,001 to 3.600 $169.69
3,601 to 7200 3233.20 j
Sewer-1st 100' ' 62,54 7,201 and greater ! $327.54 1
Sewer-each additional 100' 37.52
Water Service- 1st 100' 62.54 1Vledical 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 8e 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(err) 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 Y $148.50 for the first$10,000.00 and$1.54 for
which no fcc is specifically indicated 90.00/hr
(minimum charge-1/2 hour) and additional$100.00 or fraction thereof,to
and d including 525,000.00.
Inspections outside of normal business 90.00/hr i 525,001.00 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
Retnspection 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
1minimum charge-1/2 hour) - each additional$100.00 or fraction thereof.
Subtotal: 0 0
Other Fixtures: -r-
Commercial Fixture Worl:
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
Fixture Type for Replace/ Plan Review for Plumbing Installations
Work Performed: Capped Addeo Rebate Plan review is required for an of the following.
- any g•
Bath Tub/Shower Please check all that apply.
-Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and
Car Wash -Each Stall greater,except systems designed and stamped by licensed
-Drive Thtu _ engineer.
Cuspidor/Water Aspirator _ ❑ New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic _ ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain - U Any multipupose fire sprinkler system.
Eye Wash ❑ Any complex structure as defined in OAR918-780-0040.
Floor Drain/sink -2"
3,. Submit 2 sets of plans with any of the above.
-4"
Car Wash Drain 'Isometric or Riser Diagram-Domestic-non-food P+ ,
Disposal -Domestic-food related LI Isometric or riser diagram is required for new buildings
-Commercial-food related that meet the qualifications above.
-Industrial-fbod related
IceMaoh./Refrig.Drains
Oil Separator(Qas Station)
Rec.Vehicle Dump Station Comments regarding fixture work:
Shower -Gang _ -
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
_ -
Swimming Pool Filter
-
Washer-Clothes
Water 1Gxnacror *Note: If the fixture work under this permit results in an
Water Closet-Toilet - Increase of sewer EDUs,a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
C:\Users\owner\Google Drive\J's Company Drive\CUSTOMER COMMESCIAL BID FILES\Bids12015 Bids\iFly-Tigard\City of Tigard Irrigation
Permit Application.doc