Permit (176) a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00006
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/11/2016
Parcel: 2S111AD21400
Jurisdiction: TIGARD
Site address: 8615 SW PINEBROOK ST
Project: Brittany Homes Subdivision: 2015-021 PARTITION PLAT Lot: 1
Project Description: Backflow for irrigation.
Contractor: GRAVITY PLUMBING Owner: BARE LLC
14935 S. GREEN TREE DRIVE 22275 SW SCHOLLS-SHERWOOD RD
OREGON CITY, OR 91045 SHERWOOD, OR 97140
PHONE. 503-490-0763 PHONE:
FAX 503-650-3866
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/11/2016 $31.27
Specifics: 1 12%State Surcharge- 01/11/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 01/11/2016 $41.23
Class of Work: ALT Plumbing
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, Slate of OR. Specialty Codes and all other
applicable law. Alt 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 180days. 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 questions to OUNC by calling 503.232.1987 or 1.800.33 . 344.
Issued By: v1 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 Application
Building Fixtures
City of Tigard Received //
�� " Ile By: f �J y Permit Na:
13125 SW Hall Blvd.Tigard,OR 9722x• Plan Review
■ Phone: 503.718.2439 Fax 503.5�'d� V o1�j Datc�By: Other Permit No.:171
Inspection Linc: 503.639.4175 ` 1 �- Date Ready/By: Jud' 0 See Page 2 for
Internet: www.tigard-or.gov N PR tified/Method: Supplemental information
�i 1 Ir).:fos,1
New construction ❑D N For special inormaln use�checkfFs
Description Qt . Ea. Total
❑ Addilion/altemtion/replacement ❑ New 1-2-family dwellings(includes 100 ft.for each utility connection)
NOWSFR(1)bath 312.70
I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑ Accessory building ❑Multi-faintly SFR(3)bath 500.32
Each additional bath/kitchen 25.02
El Master builder EI Other:
Fire sprinkler(_sq.it.) Page 2
R�FbR18'-XT>t(ft�`A4O [ACATION Site utilities:
Job site address: �rp(� .W s ,yt �,� Catch basin or area drain 18.76
Drywell,leach line.or trench drain 18.76
City/State/ZIP: / F- � Fooling drain(no.linear fl.._I Paget
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear fl.:_) Page 2
Storm sewer(no.linear Il.:_) Page 2
Water service(no.linear li.: 1 Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Back0ow presenter 31.27
OF7S6tRM KOPf OF}YORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking foumain 25.02
Ejectors/sump 25.02
- ❑ TKXANT1 Expansion tank 1251
Name:
Fixlure'sewer cap 25.02
R
Floor drain floor sink hub 25.02
Address: 2y7 's_ ��.✓»y ,
Garbage disposal 25.02
City/State/ZIP: may- 02 97 Hose bib 25.02
".Phone:(ly ) Z���� Fax:( )J,W- �l�yl Ice maker 12.51
,`r(,.tfa Interceptor/grease trap 25.02
Business name: a!rr'rr�Y, Medical gas(value:$ 1 Page 2
Primer 12.51
Contact name:
Root drain(commercial) 12.51
Address: f V Sees'- ♦O�OvO /� . Sink basin lavatory 25.02
City/State/ZIP: a a0 '/Yo Solar units(potable water) 62.54
Phone:( ) - Z( Fax: :((� ) - YL Tub shower shower pan 1251
E-mail: Urinal 25.02
r.f' em�f/NG. L.�a+'s-
k rea. :3 Water closer 25.02
p_ �` -'�'" Water heater 37.52
Business name: rY1 A- Water piping-DW V 56.29
Address: Ver: 25.02
City/State/ZIP: ?aqSubtotal 31.9L7
Phone:( t ) qqnFax:( ) Minimum peril fee: $72.50 7 SC)
) Planreview (25%ofpermit fee)
CCB Lic.: l j Plumbing Lic.no.: h (;-
State surcharge(12%of peril feeZO)
Authorized signature: TOTAL PERMIT FEE iao
Print nam QL,a/z� Date: V This permit application expires if a permit is not obtained within Igo days
after it has been accepted as complete.
'Pea methodology set by I'n4 ourto Building Industry Service Board.
1-%,kbny P,11isl PLMUPamirApp.doe 1001 119 440-1611 x1002 COM"113)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
1.n4
Footing drain- 1" 100 50.03 0 to 2,000 $121.90
Footing drain-each additional 10037.52 2.001 to 3.600 $169.69
3,601 to 7,200 1 $133.20
Sewer- Ist 100- 62.54 7,201 and greater I 5327.54
Sewer-each additional 100' 37.52
Water Service- I sl 100 62.54
Medical Gas S stems:
Water Service-each additional 100' 37.52
Slomi&Rain Drain- 1st 100' 62.54 Id
$1.00 to$5.000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to 510,000.00 $72.50 for the first$5,000.00 and 51.52 for
each additional$100.00 or fraction thereof.I(,dbther T DI ]PEGS Oir-r «t� and including$10,000.00.
Inspection of existing plumbing or for S 10.001.00 to 525.000.00 5148.50 for the first S 10.000.00 and S1.54 for
which no fee is specifically indicated 90.00 In each additional S 100.00 or fraction thereof.to
(minimum charge-h2 hour) and including$25,000.00.
Inspections outside of normal business 90.00.'11 S25,001.00 to 550,000.00 $379.50 for the first 525,000-00 and$1.45 fin
hours(minimum charge-2 hours) each additional$100.00 or fraction thereat;to
Reinspection Fees 90.00/lir and including$50,000.00.
Additional plan review for revisions 90.00/11 550,001.00 and up $742.00 for the first$50,000.00 and$1.20 lilt
(minimum charge-1/2 hour) each additional$100.00 or fraction there(,].
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:.
uanti by Fixture Type Plan review is required for any of the following.
Fixture Type for Rep ice/ Please check all that apply.
Work Performed: Capped Added Reloeah
❑ Ani new commercial building with +cater senice 2"and
Baptistry Font greater,except systems designed and stamped by licensed
Bath: -Tub Shower
-Jacum Whirlpool engineer.
Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive Thin as defined in OAR918-780-0040.
('us idor/Water As irator ❑ Medical gas and vacuum systems for health care facilities.
Dishwushei: -Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Di inking Fountain
Eve Wash Submit 2 sets of plans with any of the above.
Floor Drain sink: -2*
-3 )sometnic,orRher Dla am
-4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
carnage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach. Refri .Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Ret'. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav i Bar non-food related
-Bradley
-Com,Serv/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
Washe-Clothes fees assessed for the sewer increase must be paid before the
Watci Enrat- plumbing Water Closet-Toilet P g Permit can be issued.
Urinal
Other Fixtures:
I:ABullding+Pcrmits,PLMF-PemiitApp.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
8615 SW PINEBROOK ST, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00006
David Young
3/4" Wilkins model 950, serial # 3970345. Left side back of covered porch.
Violation Summary:
Inspector Contractor