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Permit (160) CITY OF TIGARD PLUMBING PERMIT IIIIII I • ' COMMUNITY DEVELOPMENT Permit#: _ PLM2017 00060 T f i;A I<D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/28/2017 Parcel: 2S 112C B 18400 Jurisdiction: Tigard Site address: 15110 SW 81ST AVE Project: Corbin Estates,Lot 1 Subdivision: CORBIN ESTATES Project Description: Installation of residential backflow preventer for irrigation. Lot: 1 Contractor: SUMMIT LANDSCAPE LLC Owner: JT ROTH CONSTRUCTION INC PO BOX 3610 12600 SW 72ND AVE, STE 200 HILLSBORO, OR 97123 TIGARD, OR 97223 PHONE: 503-380-7618 PHONE: 503 639-2639 FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 02/28/2017 $31.27 Specifics: 1 12%State Surcharge- 02/28/2017 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 02/28/2017 $41.23 Class of Work: OTR 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: C / f 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 Application Building Fixtures FOR OFFICE USG ONLN' City of Tigard Received 13125 SW Hall Blvd.,Tigard,OR 97223,.. Date/By: ��f,Qr /7 A 4 Permit No.: pi ,J�b/'�e560 in IN a Phone: 503.718.2439 Fax: 503.5918:IO�e c Plan Review C d t Inspection Line: 503.639.4175 ill() ` Date/By: Other Permit No.: �!)��v4�3/v TIGARD p Internet: Line:www.tigard-or.gov t Ready/By: Juns Date q `T Notified/Method: I S See Page 2 for TYPE e &k ryt r,9"h, l Supplemental Information 4-` k.;I`1 FEE* SCHEDULE jb New construction 0 Demolition For special information use checklist ❑Addition/alteration/replacement Description Qty. Ea. Total ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath Z1-and 2-family dwelling 312.70 ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 ❑Master builder Each additional bath/kitchen 25.02 0 Other: JOB SITE INFORMATION AND LOCATION Fire Site uprinkler( sq.ft.) Page 2 utilities: Job site address: /s'7i 0 540 ?)V'Pry„ Catch basin or area drain O 18.76 City/State/ZIP: Et,,,ft �_ty r1 Drywell,leach line,or trench drain 18.76 Footing drain(no,linear ft: ) Page 2 Suite/bldg./apt.no.: Project name: `7 Cross street/directions to job site: Manufactured home utilities 50.03 Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision: Water service(no.linear ft.:_) Page 2 r�*; t , .5 I Lot no.: ) Fixture or item: Tax map/parcel no.: Backflow preventer i 31.27 ' DESCRIPTION OF Wi'ORK Backwater valve 12.51 � e Cir,--14111,JI Clothes washer w � 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 It] PROPERTX oW 41ER- r. 1 0 TENANT Expansion tank 12.51 Name: 1' Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 City/State/ZIP: Garbage disposal 25.02 Phone:( ) Hose bib 25.02 Fax:( ) Ice maker 3. 1...1 12.51 L7• icANT" : ©®CONTACT PLitsoN.. Interceptor/grease trap 5.02 Business name: Medical gas(value:$ Page 2 Contact name: Primer 12.51 Address: Roof drain(commercial) 12.51 City/State/ZIP: Sink/basin/lavatory 25.02 Solar units(potable water) 62.54 Phone:( ) I Fax: ( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 ,,, Water heater 37.52 Business name: c qtr {L t o4/40.,,,.&544,41.1 l Address: t Water piping/DW V 56.29 C, 0 Other: 25.02 City/State/ZIP: 14 ('I; Ism r.a 1fa3 Subtotal Phone:O 8 4,-4618 Fax:( ) Minimum permit fee: $72.50 CCB Lie.: i.,T g,,l,,� Plumbing Lic.no.: Plan review (25%of permit fee) Authorized ,...4 e signature: C .,. �Jf� State surcharge(12%of permit fee) Print name: retto `.. TOTAL PERMIT FEE (Jl o10 t'�} p,,,,-....t .. Date: t /€/ ,..14zThis 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. I:ABuildingAPermits\PLMU-PertnitApp.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 Qty. Fee(ea) Total Square Footage: Permit Fee: 0 to 2,000 $121.90 Footing drain-l'100' 50.03 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 each additional$100.00 or fraction thereof,to Other Inspections or Fees Qty. Fee(ea) Total 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 90.00/hr each additional$100.00 or fraction thereof,to which no fee is specifically indicated and including$25,000.00. (minimumnpchargeoutside of hour) Inspections normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for each additional$100.00 or fraction thereof,to hours(minimum charge-2 hours) 90.00/hr and including$50,000.00. Reinspection Fees 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 Review for Plumbing Installations r 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 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 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" SQmetl'1C or Riser I)lagralYl." _3„ -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 Comments regarding fixture work: Ice MachiRefrig.Drains 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 plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 15110 SW 81 ST AVE, TIGARD, OR, 97224 Record Type: Residential - Plumbing Inspection Type: 399 Plumbing final Result: PASS- NoCofO Comments: Tel: 503.718.2439 Inspection Date: Record ID: PLM2017-00060 Inspector: Aaron Cillo-Gobel Backflow preventer Wilkins model 350 ser#A600691 approved with test report. Violation Summary: Inspector Contractor