Permit (206) CITY OF TIGARD PLUMBING PERMIT
Fri a COMMUNITY DEVELOPMENT Permit#: PLM2016-00608
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/19/2016
T[ ` g Parcel: 2S112DB00100
Jurisdiction: Tigard
Site address: 15175 SW 72ND AVE
Project: Landmark Ford Subdivision: FANNO CREEK ACRE TRACTS Lot: 45
Project Description: Backflow preventer for irrigation.
Contractor: POWER PLUMBING CO Owner: UNION PACIFIC RAILROAD CO
PO BOX 19418 1700 FARNAM ST, 10TH FL SOUTH
PORTLAND, OR 97280 OMAHA, NE 68102
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/19/2016 $31.27
Specifics: 1 12%State Surcharge- 12/19/2016 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 12/19/2016 $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 a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued 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.
DEC-16-2016 11:24 From: To:5035981960 Paee:1'2
Plumbing Permit Application
Building Fixtures FOR Oil ICI:: USE ONL1
City of Tigard Date/8y ` 4 �` ,
g Re Date/8y: /� d 1 I(Q t�rmit No.: �Ji�//(f'C��LIi)
+ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 7c[ [1
III
r2 •
Phone: 503.718.2439 Fax: 503.5 _ CSDate/By: Other Permit No.:
'i i C,,t it f� Inspection Line: 503.619.4175 Date ReadyBy: J;e�ns,l H See Page 2 for
Internet: www-tigard-tr.gov ���� Notified/Method:. Supplemental Information
- TYPE OF. WORK q'c.,
r + IH3r)* SCS 1)1J
❑New construction ❑Demolition " �`� For special information ase checklist. n
�,"i O c %u Description I Qty. I Ea. I Total
Addition/alteration/replacement 0 Orf e., '" ` New 1-2-famlly dwellings(includes 100 ft.for each utility connection)
. , .'CAT]i6Ok1X OF CoNS 'R' 4 ,�� '', " SFR(1)bath 312.70
ID1-and 2-family dwelling sCommercial/industrial YSFR(2)hath 437.78
SFR(3)bath 50032
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02 _
❑Master builder 0 Other: _ Fire sprinkler( sq.ft.) Page 2
.-,' ::JOB;SITE-0 RMATION,,AND 1..0A;11,01..) . , Site utilities:
Job site address:r is] 7S j 7Z H /4 V 444.44_ Cutch basin or area drain 18.76
Diywcll,leach line,or trench drain 18.76
City/Statc/ZIP: 7)1Qle, e'7Z 23 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt,no.: I Project name: j.4 7 y/a.4.-,z_ i . 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 t
Subdivision: I Lot no:: pyre or Item:
Tax map/parcel no.: Backflow preventer J 31.27 31.2,7T
c," >c; :1? , ,1:'bESCRIP,.TION;'OF.WORK ','..1'; '` 1'.., . > ' Backwater valve 12.51
Clothes washer 25.02
R1/2l4 (-to7 t?a GAP/4 it:J 0 vi'r r _Dishwasher µ 25,02
Drinking fountain 25.02
Ejectots/sump 25.02
•`,, + 0 PROEERTY OWNER I`;,' u. , ! Lie 'F:N,ANC y: , is 'i>.. r Expansion tank 1251
Name: 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
! s , "'r,: 0 is011 ANT 1: >13:'coNiAth PERSON interceptor/grew=wap 25.02
Business name: pQ aler �j�6/e,i9 Gr, • Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: �'K �4� (commercial)+"` �.�r Roof draincenrtmercial 12.51
Address; L SW M u l+14 e 1✓vt aJdt_-' e>1 V!� Sink/basin/lavatory 25.02
City/State/ZIP: ^b j J li e_ c"'?2 ,3 Solar units(potable water) 62.54
Phone:(5'01.((.4--l got/ I Fax::(,9:4) . t.1(.4 .gg"1- Tub/shower/shower pan 12.51
E-mail: Se I'V i t L _e p!��Q✓Q b I 60 . to am-- urinal 25.02
1 et
CONT1tACxOR /`' Water closet 25.02
Business name: . p> . .. /_ _Water heater 37.52
I d um/r ` �G1�i' b/f� C o Water pipingfDWV 56.29
r Address: PO 13t)x 1914/8' Other 25.02
City/State/ZIP: D i,71-fAd,t, ()le 177 -O Subtotal 3), a-7
Phone:(Q3) a y y-/gQt Fax:(, 3)21/1" 0 02 - Minimum permit fee: $72.50 yz•.5-b
Phone:
5237e Plumbing Lic.no.:3 r�sz 1P - Plan review ( ofpermitf ) �^
State surcharge(112%2% ee
of permit fee) ?_7 Q
Authorized signature: C.test J 4 ,. r d_S TOTAL PERMIT FEB feJ,�.0
Pilot name: L& _-,' _ bDate: /� /�//7 is permit apptieatioattere it expires ifbeen a perrottaccepted Iaas notcanpkte obtalned within 180 days
/ Mas
*Fee methodology set by 7Yi-County Building Industry Service Board.
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DEC-16-2015 11:24 From: To:5035981960 Page:2/2
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
• Site:Utilities Qty ;Fee(ea) . Total Square Footage:;:','; ' :. •Perinit Fee: , ... .
Footing drain-1"10() 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' _ 37.52 2,001 to 3,600 $169.64
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
'.V $Aliatifili: • '• "Peemllt Fee:•: : ' _ ,.. ..
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Sturm&Rain Drain-each additional 100' 3752 $5,001.00 to$10,000.00 57250 for the first$5,000.00 and$1.52 for
Other xillis Ctio 1s�,Ur l;ees ,QtY;` Fes(ea') , ' '.otal; each additional$100.00 or fraction thereof,to
pe , and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $14850 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90,0(1 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 hour) 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',
.. • ,. •Quantity by Matur Typt:" `,PlanRiview for.,Pl'u'.mibiing installations
Fixture Type for '. • ' Reof°'x/ Plan review is required for any of the following,
Work'Performcd: , .,. Cappeq . Added 'aeteciite
Baptistry/Font Please check all that.apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
Jacu��.Jwh;rlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thm 0 Ncw exterior plumbing site utilities for any complex structure
Cus.idur/Water .irattx as defined in OAR918-780-0040.
Dishwasher -Conunercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
-
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink .2" Submit 2 sets of plans with any of the above.
-3"
+ l Isometricor Riser Dia"ram
Car Wash Drain
Garbage Domestic non-food Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-fax!related
Ice Mach/Rettig,Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sinit/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swin i"i Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor "— increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinalplumbing permit can be issued.
Other Fixtures:
A
http://www.tigard-or.gov/ m nt,-cent /Building/T'LMF_PennitApp.dS