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Permit (25) .'R CITY OF TIGARD PLUMBING PERMIT .11111 COMMUNITY DEVELOPMENT Permit#: PLM2016-00451 T f{ ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2016 Parcel: 2S111 CC19200 Jurisdiction: Tigard Site address: 10335 SW GREENLEAF TER Project: KIRSCHNER Subdivision: SUMMERFIELD NO.5 Lot: 251 Project Description: Backflow for irrigation. Contractor: MONTERREY IRRIGATION SERVICES LLC Owner: KIRSCHNER, LINDA M 4715 SE 94TH AVE BURKE, KATHRYN J PORTLAND, OR 97266 10335 SW GREENLEAF TER TIGARD, OR 97224 PHONE: 503-568-9604 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 08/22/2016 $31.27 Specifics: 1 12%State Surcharge- 08/22/2016 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 08/22/2016 $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, 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 a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: r -ermittee 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 Permit No.: 5-1 14 13125 SW Hall Blvd.,Tigard,OR 972 S ', `" Date/By: f(p er f - (� _ Phone: 503.718.2439 Fax: 503.5984%11 Plan Review a Other Permit No.: Inspection Line: 503.639.4175 Date/By: T I G A R D Date Ready/By: kris. la See Page 2 for Internet: www.tigard-or.gov Notified/Method: ' cy �� Supplemental Information TYPE OF WORK R\M B FEE* SCHEDULE / ❑New construction 0 Den4itiotl For special information use checklist. 1 I , 8 3 d�• Description Qty. I Ea. Total ❑Addition/alteration/replacement ❑Ot1� w 1,.. ,,„:, New 1-2-family dwellings(includes 100 ft.for each utility connection) ' CATEGORY OF CON ON =" SFR(1)bath 312.70 12-1--and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: /Q 35- _54/ e3 ye Ph 1 eG-f f-r )-1, Catch basin or area drain 18.76 3 Drywell,leach line,or trench drain 18.76 City/State/ZIP: ?"l /�q Y 0 l2 5‘ _2 A. y 1. 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: Lot no.: Fixture or item: ,/ Tax map/parcel no.: Backflow preventer 6' 31.27 yid-7 1', '1'1' ES(C!RIP1'ION '77 r,W ch Backwater valve ,, ,.. 12.51 ` Clothes washer 25.02 .5/9 1'/" i A le v ..9,5fe M ).5fia 71/d./AL Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 O �PROPEi ?7l WD Expansion tank �, � � NE a; � 'I'�NAN� <<; �� -tai P 12.51 Name: / Fixture/sewer cap 25.02 , h elCk. I Y C� tr Floor drain/floor sink/hub 25.02 Address: /f� 3 3 5 8.61, C' Y?r t. [ Pc^1 91.1. y-t- Garbage disposal 25.02 City/State/ZIP: fil-, Div-c,j 7/ /),p 7 15 2 1i Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 I'APPLICANT '0 CONTACT° PERSON Interceptor/grease trap 25.02 Business name: _AI© � f1, y key -Ty yl, c-1t�,a pL Sell-1 c3 Medical gas(value:$ ) Page 2 Primer Contact name: (...,,---15 el U I�/ /mar y,j ✓ 12.51 _ �` Roof drain(commercial) 12.51 Address: I/?" 5 5c.- 2.,r 4- A-Ci Sink/basin/lavatory 25.02 City/State/ZIP: ,0 t/' a t...(I © i#7 /)Z 02 t/' Solar units(potable water) 62.54 Phone:(�0� 5-‘� a) 111 b zit Fax: :( ) t- Tub/shower/shower pan 12.51 E-mail: c �AC�- / ; le Urinal 25.02 )140ltryr cvv-v.q '� n . cv r`'\ " r Water closet CONTRACTO 25.02 Water heater 37.52 Business name: irv._ osC.?�_A 1 S 6d`re Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal 3/...41-7 Phone:( ) Fax:( ) Minimum permit fee: $72.50 "7 ),� CCB Lic.: ii ,2 Irv, Plumbing Lic.no.: Plan review (25%of permit fee) /�- State surcharge(12%of permit fee) (`7) Authorized sign /uga ciyl•7��e'2 /l TOTAL PERMIT FEE �) Print name: Date:Q .--22 f‘ 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. 1:\Building\Permits\PLMO-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Qty. Fee(ea) Total Square Footage: Permit Fee: Site Utilities w 9 Footing drain-l'100' 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 Valuation. Permit Fee: 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 Fie " Total each additional$100.00 or fraction thereof,to Other Inspections or Fees ' 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 each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) 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,Re iew:for 1lumbing 1ns *ll. " On ' '' Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace! Please check all that apply. t l R Capped Added Relocate Work Performed: 0 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 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Tluu 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial -Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" Isometric or Riser Diagram x 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications 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/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\PLMF 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 10335 SW GREENLEAF TER, TIGARD, OR, 97224 Residential - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2016-00451 Don Sylvester 1" double check model Wilkins 350 serial #A574221 located by meter approved with test results Violation Summary: Inspector Contractor