Permit (18) p CITY OF TIGARD PLUMBING PERMIT
il{ COMMUNITY DEVELOPMENT Permit#: PLM2016-00452
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2016
Parcel: 1 S134CA05900
Jurisdiction: Tigard
Site address: 12045 SW BURLHEIGHTS ST
Project: TOSTI Subdivision: BURLWOOD NO.2 Lot: 32
Project Description: Backflow for irrigation.
Contractor: GREAT GARDEN LANSCAPING LLC Owner: TOSTI, MELISSA R
1157 ELANA DR 12045 SW BURLHEIGHTS ST
WOODBURN, OR 97071 TIGARD, OR 97223
PHONE: 503-989-5513 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 $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232, •: . 2.2344.
Cj.....,____Th .,,v,r--.
Issued By: 'ttee Signature: kit
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Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
�N FOR OFFICE CSG ONE)°
1a
City of Tigard r;,t Received ,j
Date/By: p Permit No.: ^ +\
74
13125 SW Hall Blvd.,Tigard,OR 972 l� Y (i�`L� `(� �
Phone: 503.718.2439 Fax: 503.598.1960 6� }\ Plan Review
1� Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 La
N R 'Date Ready/By: ,7yr y ® See Page 2 for
Internet: www.tigard-or.gov ,' r fC p
d Method Supplemental o
���w%t pp ental Informafi n
TYPE OF WORK e i,-,Alt .., FEE* SC$EDULE.
�t,C
❑New construction 0 De tloir For special information use checklist
A _% Description
Qty. Ea. Total
o Addition/alteration/replacement 0 Otter: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRIJCnON SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
o 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
JOE SITE INFORMATION AND LOCATION Site utilities:
Job site address: 126 vs S Uj go, ,„/ e Catch basin or area drain 18.76
City/State/ZIP: �r1 Drywell,leach line,or trench drain 18.76
ty �l Q id i nit- C/ L?j 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
5 L ) 1 ZI.4-Ct AV® ' (,) s,-1- S►4 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 1.27 3).1--)
` 'DESCRI I ION O WORK" ` j , , Backwater valve 12.51
S(J^n n V:10-r--
o c-C4 ` ' ,,- C' j Diswasher 25.02
.D [��1/'� � Dishwasher 25.02
et1,3 ►\Ay, 1-t‘. -,- Drinking fountain 25.02
Ejectors/sump 25.02
l ❑ PROPERTY WNE1t r #,„ ' - [ ANT Expansion tank 12.51
. x; u „: „,,,, `C ars.
l% s q .y--cc,S Fixture/sewer cap 25.02
Name: l"f ie
Address: 'L 0qE %l! r Floor drain/floor sink/hub 25.02
vn/ 11 Tf S`r Garbage disposal 25.02
City/State/ZIP: .t-i Q a,.T IQ, l2 L-
4 / Hose bib 25.02
Phone:(„.„5.jj = ? 6 ys f Fax ( ) Ice maker
12.51
0 APIUCANT" ,0=CONTIG N Interceptor/grease trap 25.02
Business name: �7 r t ak G C1 t 4,h i _n r j C�,q e('na . Medical gas(value:$ ) Page 2
f 1� Primer 12.51
Contact name:
rCl V t er �' y1 S ` c
"� Roof drain(commercial) 12.51
Address: I -11'1( E d W yr Rd , N .i Sink/basin/lavatory 25.02
City/State/ZIP: t.i0 60.3k) t 9 0 ie.. , 9 7 0.7/ Solar units(potable water) 62.54
Phone:(5t 7 (i., fir-s_ 73 Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTR ICTOR
Water closet 25.02
Business name:
Water heater 37.52
A Water piping/DWV 56.29
Address:
Other: 25.02
City/State/ZIP: Subtotal 3 ,r2 7
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7),,SI.)
CCB Lic.: j� Plumbing Lic.no.: Plan review (25%of permit fee) -�
j
State surcharge(12%of permit fee)
Authorized si ature: r -7,�
TOTAL PERMIT FEE )
Print name:c- C'/ Date: 8-L 2..1/ This permit application expires if a permit is not obtained within 180 days
Ib after it has been accepted as complete.
l L-3 *Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-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:
Site Utilities Q• Fet(ea) Total Square Footage: Permit Fee:
Footing drain-15`100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52
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
{ea} Total each additional$100.00 or fraction thereof,to
Fee
Other Inspections or Fees 'Qty. l 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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr
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*. Pian Resew for Plum bitgnstaltitons
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replay/ 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
-3" Isometric or RiserDiagrant
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
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
12045 SW BURLHEIGHTS ST, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00452
Don Sylvester
1. 1" Wilkins DC, model 350, serial # A554736, for irrigation, located at front of house -
ok with test.
Violation Summary:
Inspector Contractor