Permit CITY OF TIGARD PLUMBING PERMIT
. COMMUNITY DEVELOPMENT Permit#: PLM2016-00222
T[GARS 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2016
Parcel: 2S112CB03300
Jurisdiction: Tigard
Site address: 8374 SW ASHFORD ST
Project: Burnett Subdivision: ASHFORD OAKS NO.2 Lot: 47
Project Description: Installation of residential backflow preventer for irrigation
Contractor: OWNER Owner: BURNETT, BRENT J &DARCEE K
BRETT& DARCEE BURNETT 8374 SW ASHFORD ST
8374 SW ASHFORD ST TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 617-543-5522 PHONE: 617-543-5522
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/21/2016 $31.27
Specifics: 1 12%State Surcharge- 04/21/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/21/2016 $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 -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or d ct questions to Ob'C by calling 503.232.1987 or 1.800.332.2344.
Issed Btf / 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 App
ittlef LW
Building Fixtures
City of Tigard o R 21 2onfll!6 Receivedpennit No.: n
NI 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Date/By: `�p (,f��D/(��eZr�i
: • Phone: 503.718.2439 Fax: 9 61FA(4 gt) Date/By:eview
X %.71
1�, Other Permit No.:
Inspection Line: 503.639.4 ,,,� I Date Read /B
I I t -\1:.1) Internet: www.tigard-or._ l Ready/By: Juris. Supplemental
See Page 2 for
1 r Notified/Method: Supplemental Information
El 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)
as � » �� .,,.-.> _;.:',�... ,F 0.,1;. 4z,,N, .., ,: „O. I r", SFR(1)bath 1
437.78
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath
lit
❑MasterAccessorybuilding
SFR(3)bath I t
g 0 Multi-family
Each additional bath/kitchen
.32
❑ builder 0 Other
*« 25.02
Fire sprinkler( sq.ft.) Page 2
,11-..--;,•;;;4:4 . , y ` B.,4 Q 4 .1 (,r Site utilities:
Job site address: f3 7 q (5 I,,) ,.-541--r-04) Sr- Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
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 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 f 31.27
a a Backwater valve 12.51
.-. , . „az,6,,..e r . .1... -. . w- Q,gn_4,"1,:f. �.,(g�. ,-, M Clothes washer
;' Iv id .1'45041r,1" Ftil lrV' ' -1 `0 25.02
Dishwasher 25.02�j'i Drinking fountain 25.02
Ejectors/sump 25.02
�k ..4 e e N„ t '€ t,0 r a a; : Expansion tank 12.51
-. 'e .%dm 1.�. ,'t�' ... ..aik € ,�...„ v ,at�'«»,y uu't, � s ` 44i x'
Name: wow t u„,-c ee. Fixture/sewer cap 25.02
\it
Floor drain/floor sink/hub 25.02
Address: 1. 4„3 S Garbage disposal 25.02
City/State/ZIP: "T;ri,- ay.-4722y Hose bib 25.02
Phone:(6(Z ) st.Rcc Fax:( ) Ice maker 12.51
.. . 0; '-'4410c1444/..TIF.';;;: *c'*, Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
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
.� +.a'':,:,,v,'
,
s
25.02
'''''';:t."77:'fxA1 e: Ys ms„ t Six Water closet
` dxa m l e,, * ., c �& n .. CK w , Sdw
Water heater 37.52
Business name: OWN K Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) ... Minimum permit fee: $72.50 Toe•CO
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
-+ State surcharge(12%of permit fee) k-70
Authorized signature:\ k_Ru/j tt TOTAL PERMIT FEE 7`.‘19-6Print name: Date: This permit application expires if a permit is not obtained within 1 0 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:,Building,.Permits,.PLMU-PennitApp.doc 1091:09 440-4616T(I0 02 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Residential Fire Sus s ression e Schedule: S stems:
Qtye e
f, 4..,{ g " 4 t CC '* p r
b, acs.* s. +�anf- r a. ro ' ."t�. ,. .I
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 S stems:
Water Service-each additional 100' 37.52x s
E a
Storm&Rain Drain-1st 100' 62.54 4 :tr
$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
r n x each additional$100.00 or fraction thereof,to
i= a7' 5' �an ',.� * �' +> _ 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*. F -****V:#. . i r E _Installations t,
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
❑ Any new commercial building with water service 2-and
Baptistry/Font _ greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing-site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
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"
4„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet theq ualifications above.
Garbage -Domestic non-food
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/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
Ovate,Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:A Building\Permits\PLMF_PermitApp.doc 08/04/2011 2