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Permit (129) CITY OF TIGARD PLUMBING PERMIT 3 : COMMUNITY DEVELOPMENT Permit#: PLM2016 00126 T IG ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/09/2016 Parcel: 2S103BB06100 Jurisdiction: Tigard Site address: 12517 SW 123RD AVE Project: English Hayes Partition,Lot 3 Subdivision: BROOKWAY Lot: 61 Project Description: Installation of residential backflow preventer for irrigation Contractor: ALL METRO LANDSCAPE Owner: WESTWOOD HOMES LLC PO BOX 1812 12700 NW CORNELL RD BEAVERTON, OR 97075 PORTLAND, OR 97229 PHONE: 503-481-4732 PHONE: FAX: 503-372-9162 FEES Quantity Description Date Amount 1 ea Backflow Preventer 03/09/2016 $31.27 Specifics: 1 12%State Surcharge- 03/09/2016 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 03/09/2016 $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 N. -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952- 010090. You may obtain a copy of the rules or. ct questions to • N ailing 503.232.1987 or 1.800.332.2344. / /1 I sued By: 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 RECEIVES City of Tigard Received M/ r Date/By: /gyp Permit No.: L ��/ L 41 13125 SW Hall Blvd.,Tigard,OR 9 fl Date/By:Plan Review 111 s Phone: 503.718.2439 Fax: 503. 60 Other Permit No.: lJi�,,e:f 5j - Z Inspection Line: 503.639.4175 I I t�:1 It I) g g f t 1.16A L11► Date Ready/By: lulls: ® See Page 2 for Internet: www.ti and-or. ov l/f ARE) Notified/Method: Supplemental Information TYPENG DIVISION En*.sc 0 New construction 0 Demolition For special information use checklist. Description I Qty. I Ea. I Total O Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 1:11-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 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: 6 r 'j (/�1 1Z3Vt� i Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: ri.--!.�G._ 6 V t• n r__ Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: ✓ Project name: E,jd,0 # 1,4#ygs P#2n"r Manufactured home utilities 50.03 Cross street/directions to job site: 6 0 Manholes 18.76 l 23 /tW Ak:1,1 Ogi---- 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: 1 Lot no.: 3 Fixture or item: Tax map/parcel no.: 'Backflow preventer r. 31.27 1 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 B' % -c ' 01.✓ Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: SST-VO C 9 N�5 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 gi APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Tic �N t� Medical gas(value:$ ) Page 2 Art-Business name: A � ME Primer 12.51 Contact name: V t t,) "l1 eOL V S Roof drain(commercial) 12.51 Address: 17 0 80 K (A3 1 Z Sink/basin/lavatory 25.02 City/State/ZIP: Iv%"t?J ©p- 97p-7 Solar units(potable water) 62.54 Phone:(,S3) 'B i 41)2_ Fax: :( ) Tub/shower/shower pan 12.51 E-mail: A l` z e j h c_ t�s P Co CAA. I-x vi•c--- Urinal 25.02 CONTRACTOR Water closet 25.02 - Water heater 37.52 Business name: I fit/MCF... Water piping/DW V 56.29 Address: Other: 25.02 City/State/ZIP: \\R Subtotal Phone:( ) \'tf)k, Fax:( ) Minimum permit fee: $72.50 ic.: (ijA-j '1 l%1 p Plumbing Lic.no.: Plan review (25%of permit fee) s State surcharge(12%of permit fee) Authorized signature: • TOTAL PERMIT FEE k. Print name: V+.1.4N , Date:;3 +L( I ' This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1r Building Permits PLMt1-PermilApp.doc 10 0109 440-4616T(10 02 COM WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site'Utilities ` Qty. Fee(es) 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-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 a�utibn: 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 �' Fee Oa) Total and includingial 10,$100.00. or fraction thereof,to and $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$50,00.0.00. 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*. 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 El Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. ElDishwasher: Commercial Any multipurpose fire sprinkler system. Domestic El Any complex structure as defined in OAR9 I 8-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2• 3•• Isometric or'Riser Diagram ❑ 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 Mach./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/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 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\P LM F_PernitApp.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 12517 SW 123RD AVE, TIGARD, OR, 97223 Residential - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2016-00126 David Young 1" Wilkins model 850, serial number A 538917 located left side of house at street side. Violation Summary: Inspector Contractor