Permit (82) CITY OF TIGARD PLUMBING PERMIT
1 . COMMUNITY DEVELOPMENT Permit#: PLM2016 00159
T!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/28/2016
Parcel: 2S102BC04400
Jurisdiction: Tigard
Site address: 10605 SW WATKINS PL
Project: Moreno Subdivision: WATKINS PLACE Lot: 1
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: JOHN DARBY LANDSCAPE INC Owner: MORENO,AARON A&MARY R
13867 SW BENCHVIEW TERRACE 10605 SW WATKINS PL
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-314-3117
HONE: 503-579-5298
FAX: 503-524-6613
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/28/2016 $31.27
Specifics: 1 12%State Surcharge- 03/28/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 03/28/2016 $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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain ..y of the rules
or dire uestions to •. C by calling 503.232.1987 or 1.800.332.2344.
Issu d By: $ ae- ,k/4--ieL0 Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next av ••mspec n date.
This permit card shall be kept in a conspicuous place • l- site until completion of the project.
Approved plans are required on the' ite at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVED
Received Q
City of Tigard yl/�A 2 8 Date/By: a0 ( Permit No.: 4/f i 60..�j(5�
14 Ill 13125 SW Hall Blvd.,Tigard,OR 97d tAR 2016 Plan Review Ov
• Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit No.:
Inspection CITY Y OF TIGARD Ready/By:Line: 503.639.4175Date Read /B ®furls. See Page 2 for
11 t,,\t.I Internet: www.nand-or. ov
. g g BUR DING niVISION Notified/Method: Supplemental Information
' TYPE OP WOK .FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑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
g 1-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 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: LOG d6 S ;.04-1,\<01\c„ p`cc Cr_ Catch basin or area drain 18.76
Q �(� a� Drywell,leach line,or trench drain 18.76
City/State/ZIP:
t J�V� f0 ci7 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 5to W Q tS J%,/\13 Manholes 18.76
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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer , 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
_Is(f x cbCc\--`c Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
A n Fixture/sewer cap 25.02
Name: 1AG,cn vy'0._Ake .f MD\rt D
Floor drain/floor sink/hub 25.02
Address:
I b42 d )Lei l ,,,,� t.ac e Garbage disposal 25.02
City/State/ZIP: l-05 k\I e- Hose bib 25.02
Phone:(5o3) 3 SLI _3 L v7 Fax:( ) Ice maker 12.51
`APPLICANT' ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: :3-0
\zIl `"5Calie "A5 Primer 12.51
Contact name: J t\r‘V\ 00\02
Roof drain(commercial) 12.51
Address: t�r t )'2 g3 l Sink/basin/lavatory 25.02
City/State/ZIP: 7c u-� O . '7 g ) Solar units(potable water) 62.54
Phone:( ' 33) Cq 7g90 Fax: :(t913 52zy__6113 Tub/shower/shower pan 12.51
E marl:�y� ivAIN lq I .. L v►'I Urinal 25.02
"'``esti t r. ". . Water closet 25.02
'� Water heater 37.52
Business name:....-y0leoN p4.441)�!‘5A� c [ e_�-�["�-,-A,C ; Water piping/DWV 56.29
Address:Q I°Uj a3 it/7 l Other: 25.02
City/State/ZIP: -y- Ac 4rel pg. 1 Subtotal
Phone: J
(�" ) (
Fax: Minimum permit fee: $72.50 7a-
� �� `- ��� �� ���� Plan review (25%of permit fee) ---
LCB Lic.:'''7 1 1 0 Plumbing Lic.no.: State surcharge(12%of permit tee) . 7
Authorized signal. • �- TOTAL PERMIT FEE O/a.¢,
This permit application expires if a permit is not obtained within 180 days
Print name: a t _ a `` Date: 1�j after it has been accepted as complete.
I!� j *Fee methodology set by Tri-County Building Industry Service Board.
I:Building Permits PLMU-PernitApp.doe 10 01 09 440-46161(10 02 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities QtY- Fee(ea) 'rota'
fftsiSre°FeftiRge;.: 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
Water Service-each additional 100' 37.52 Medical Gas Systems
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 "Fee(ea) Tc'tal 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$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*. 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
-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.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 1:1 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'. .,, Isomeric 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 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 beaid before the
Water Extractor p
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:ABuilding\Pennits\PLMF_PermitApp.doc 08/04/2011 2