Permit (12) CITY OF TIGARD PLUMBING PERMIT
' 7
' 'S COMMUNITY DEVELOPMENT Permit#: PLM2017-00147
D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/27/2017
T E '' B g Parcel: 2S102CA02800
Jurisdiction: Tigard
Site address: 9685 SW FREWING ST
Project: Balfour Partition,Lot 2 Subdivision: 2016-029 PARTITION PLAT Lot: 2
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: EDWARD MULLEN PLUMBING Owner: SAGE BUILT HOMES LLC
1601 SE RIVER RD 1815 NW 169TH PL STE 1040
HILLSBORO, OR 97123 BEAVERTON, OR 97006
PHONE: 503-640-0113 PHONE:
FAX: 503-640-4483
FEES I
Quantity Description Date Amount
1 ea Backflow Preventer 04/27/2017 $31.27
Specifics: 1 12%State Surcharge- 04/27/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/27/2017 $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
Utilit 'o(ica • enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
o direct questions to a NC • •.!ling 503.232.1987 or 1.800.332.2344.
sued By: / Permittee Signature: ` ' 110
Call 503.639.4175 by 7:00 a.m.for the next available inspe P 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 USE ONLY'
City of Tigard RECEIVED an Date/B Revy iew y �� f Permit No.: paid,/7'r.�l 4.7Rt 13125 SW Hall Blvd.,Tigard,OR 972�nn Pl
_ Phone: 503.718.2439 Fax: 503.598A�6� ry 2017
/ Date/By: Other Permit No.:}*T etTOCCr t!7
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for "!
Internet: www.tigard-or.govna OF TIGARD Notified/Method: Supplemental Information
TYPE o V�� ING DIVISION PEE* SCHEDULE
®New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. [ Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION ANI) LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address:9685 SW FREWING ST
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard OR,97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name:FREWING Manufactured home utilities 50.03
Cross street/directions to job site: ,QtrP t�). - 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:FREWING Lot no.:1 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Backwater valve 12.51
DESSCRIPTION OF WORK
�-�
Clothes washer 25.02
NP df\0,A C C- )Oi/�1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
it PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:SAGE BUILT HOMES LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1815 NW 169TH PL SUITE 1040
Garbage disposal 25.02
City/State/ZIP:BEAVERTON OR,97006 Hose bib 25.02
Phone:(503)6456800 Fax:( ) Ice maker 12.51
' APPLICANT ►a CONTACT PERSON Interceptor/grease trap 25.02
Business name:SAGE BUILT HOMES LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:ALEX RODRIGUEZ
Roof drain(commercial) 12.51
Address:SAME AS ABOVE Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(971)3366911 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:ALEJANDRA@SAGEBUILTHOMESLLC.COM Urinal 25.02
Water closet 25.02
CONTRACTOR 37.52
Water heater
Business name: ED MULLEN PLUMBING Water piping/DWV 56.29
Address:1601 SE RIVER ROAD Other: 25.02
City/State/ZIP:HILLSBORO OR,97123 Subtotal
Phone:(503)6400113 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:92689 Plumbing Lic.no.:34-260PB
-- State surcharge(12%of permit fee)
Authorized signature: � ,. ',,. j �i TOTAL PERMIT FEE
K(-d-r)
Print name:ALEX RODRIGUEZ Date:- 1\ 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\PLMU-PennitApp.doc 10/01/09 440-4616T(l0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee tea) Total ' quaR a Footage: Permit Fee:
Footing drain-1°t 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 Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' Valuation: Permit,Fee:
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
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ q anyfollowing.
Plan review is required forof the
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ 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"
4„ Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
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
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\alejandra\Downloads\PLMF PermitApp.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9685 SW FREWING ST, TIGARD, OR, 97223 May 2, 2017 at 10:29:26 AM
Record Type: Record ID:
Residential - Plumbing PLM2017-00147
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Backflow assembly Wilkins model 350 ser#A594428 located right side of property
approved with test report.
Violation Summary:
Inspector Contractor