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Permit (114) • �1.„, �_�,; CITY OF TIGARD PLUMBING PERMIT it r, ' g COMMUNITY DEVELOPMENT Permit#: PLM2015-00409 Vit Date Issued: 12/01/2015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ;I t,,,, Parcel: 2S110BA11800 Jurisdiction: TIGARD Site address: 14270 SW 118TH CT Project: Medallion Meadows, Lot 11 Subdivision: MEDALLION MEADOWS Lot: 11 Project Description: Backflow for irrigation. Contractor: AUSTIN BROWN LANDSCAPE Owner: JT ROTH CONSTRUCTION INC PO BOX 14441 FOUR D CONSTRUCTION CO PORTLAND, OR 97293 12600 SW 72ND AVE#200 TIGARD, OR 97223 PHONE: 503-887-7795 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 12/01/2015 $31.27 Specifics: 1 12%State Surcharge- 12/01/2015 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 12/01/2015 $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 r les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You r .y obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or1.84111111110- • -- 44. Issued By: ` Permittee Signature: '411/ 410.41. 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 completio of th/e'project. Approved plans are required on the job site at the time of each inspect on. /� • Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY I�y' Received City of Tigard ECEI V • /A / I5 Permit No.: /° _„^f-)1 S eati C)or q II 13125 SW Hall Blvd.,Tigard,OR 97_ Date/By: tf-'yC "C 12415 Plan Review _ Phone: 503.718.2439 Fax: 503.598.1960Other Permit No.:/y) 7,20/5-- 3 ( Date/13y: J Inspection Line: 503.639.4175 DE`� Date Ready/By: Juris: l� See Page 2 for TIGARD Internet: www.ti and-or.rov Y o �y > g b I� OF-el Notified/Method: /!/�/ Supplemental Information TYPE OF V1'O'�y t I. i,%\J SIO FEE* SCHEDULE ❑ New construction r For special information use checklist. Demolition Description Qty. Ea. Total ❑ Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: /t/a..3.6 V t` 1 1 - (-i-- Catch basin or area drain 18.76 (��F�l�, � Dtywell.leach line,or trench drain 18.76 City/State/ZIP: �J /' Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Un 1 ✓L4 �t Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear It.:_) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 / DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 • {/ / ,) J}/ rGc - /✓-v "4 `! r A. crt, Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER I 0 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 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: Primer 12.51 Contact name: 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 Water closet 25.02 CONTRACTOR Water heater 56.29 Business name: , 4V �C ' A ' 1,(7/49.1647(71/4(91 Water piping/DWV 56.29 Address: 0 1: L Other: 25.02 �/� I ,� �� 2 1 City/State/ZIP: �(1 V""l 1 Subtotal Phone:( 8K-1---?-77-40, Fax:( ) Minimum permit fee: S72.50 EIMI CCB Li c.: �/ PIw ..e_Lic.no.: Plan review (25%of permit fee) -�� A ' State surcharge(12%of permit fee) IIMM Authorized sigri'ft e:7 TOTAL PERMIT FEE S /� �.J) ( e This permit application expires if a permit is not obtained within ISO days Print name: I /�/U Date: I�-Y/ ) after it has been accepted as complete. ii�� *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10101/0 440-46I6T(10/02(CON1/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- I" 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- I st 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- I st 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 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 S50.000.00. Additional plan review for revisions 90.00/hr 550,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge 1/2 how) 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 Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped• Added Relocate Baptistry/Font ElAny 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 as defined in OAR9I 8-780-0040. 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" 3 Isometric or Riser Diagram 4„ ❑ 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 Macli./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Sery/Util food related -Service *Note: If the 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: I:\Building\Permits\PLM F_PermitApp.doc 08/04/2011 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 14270 SW 118TH CT, TIGARD, OR, 97224 Residential - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2015-00409 David Young 1" Wilkins model 350, serial # A519998 located by sidewalk. Violation Summary: Inspector Contractor