Permit CITY OF TIGARD PLUMBING PERMIT
s : COMMUNITY DEVELOPMENT Permit#. PLM2015-00371
Date Issued: 10/28/2015
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503 718 2439 parcel: 1S135DB13300
Jurisdiction: Tigard
Site address 9254 SW NORTH DAKOTA ST
Project: Kraiter Subdivision: 2007-005 PARTITION PLAT Lot: 2
Project Description: Installation of residential backflow preventer for irrigation system
Contractor: GREEN THUMB LANDSCAPE&MAINTENANCE INC Owner: SMITH, LAUREN L
PO BOX 5172 KRAITER, KYLE S
SALEM, OR 97304 9254 SW NORTH DAKOTA ST
TIGARD, OR 97223
PHONE 503-707-6988
HONE 503-362-7327
FAX 503-364-6391
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/28/2015 $31 27
Specifics: 1 12%State Surcharge- 10/28/2015 $8 70
Plumbing
41 ea Minimum Fee Adjustment- 10/28/2015 $41 23
Type of Use: SF Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories-
Total $81 20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules
or direct••- io • OUNC by calling 503.232 1987 or 1.800 332.2344.
Iss -d By: Permittee Signatyre: tir°'�
Call 503 639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Site Utilities /fir 1.f..O 1 FOR OFFICE USE ONLY .
• F r � ` ' '
City of Tigard Date/By. �O�$�S c-11).2 Permit No•,4,/ n/3 '3 7/
q 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Ov
Ill Phone: 503.718.2439 Fax: 503.,5,58:f 949 7 7015 Date/By Other Permit No..
T I G A R D Inspection Line- 503.639.4175 U I 41 Date Ready/By. hurls ® See Page 2 for
Internet www.tigard-or.gov Notified/Method. Supplemental Information
TYPE OpF(��IRff°�ppt c�''!�'�(` p�1 FEE* SCHEDULE•
0 New construction El➢Wlll �biYl��i�i'bnlgOrN For special information use checklist
Description I Qty. I Ea. Total
ixAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
141-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
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,sut N (3� c(\ pc 0, Catch basin or area drain 18.76
City/State/ZIP: `-tkoi OQ �f cv-ia 3',.-
�'�+,v_
Drywell,leach line,or trench drain 18.76
h ( Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: \ bkocm� wtSt- o 0 Manholes 18.76
C v Rain drain connector 18.76
0 Sanitary sewer(no linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: l Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31•a1
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
\\{\S` ✓ (A) t ( c\c\x t u' Dishwa sher
25.02
Drinking fountain 25 02
Ejectors/sump 25 02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:
\\\� r-.a b
Fixture/sewer cap 25.02
�a k , � Floor ge disposal sink/hub 25 02
Address: \`��(•`
Garbage disposal 25 02
City/State/ZIP: V ,;nic \ Ora ' Hose bib 25.02
Phone:`Jv� ' 01, ti l� ) CO`Fax:( ) Ice maker 12.51
,ES, APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: 'GOTT1a�m� qtr\�SC1(��1( , Medical gas(value $ ) Page 2
Contact name: (3 \/A , O �A Primer 12 51
���+` ►'�J1 ��W` 1 Roof drain(commercial) 12 51
Address: (�(\� ,fl a Sink/basin/lavatory 25.02
City/State/ZIP: ����'-e Ify\ ik, ( \6 - Solar units(potable water) 62.54
Phone:kcTicialal Fa x::q%) � (j? 1 Tub/shower/shower pan 12 51
•E-marl: d (11-�.` \Va., - C ` Urinal 25.02
CO RACTOR Water closet 25 02
Water heater 37.52
Business name: (al^ IN 1F\5 b ri nd,wv� (v� Water piping/DWV 56 29
Address: ? P)1 snq Other: 25 02
City/State/ZIP:v v��ff\ C3? 00 b0L\ Subtotal '3 31
", ` t v^ p11 Wit_ Minimum permit fee: $72 50 * Q
Phone: ) 7:0,3._ � Fax:(W ) "lY 1� U �
CCB Lic.: ,2`� 9`q//i(j Plumbing Lic.no.: Plan review (25%of permit fee)
J State surcharge(12%of permit fee) ,Q
Authonzed signature: VA TOTAL PERMIT FEE a6•QQ
Print name S
,tea ®1 e'1 e+ ‘5 This permit application expires if a permit is not obtained within 180 days
��\ L Date: p(1 J after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
I\Building\Permits\PLMU-PermaApp doc 10101/09 440.46 16T(t 0/02/COM/WEB)
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-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 $233.20
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 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 C/�
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 ❑ 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 Thm ❑ 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'
4" , Isometric or Riser Piagram
Car Wash Drain
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 increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http://www.tigard-or.gov/document_center/Building/P LM U_PermitApp.d2c
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
9254 SW NORTH DAKOTA ST, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
November 9, 2015 at 9:13:22
AM
PLM2015-00371
Don Sylvester
Violation Summary:
Inspector Contractor