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Permit (22) CITY OF TIGARD PLUMBING PERMIT 1111 Ili ° COMMUNITY DEVELOPMENT Permit#: PLM2017-00232 Date Issued: 06/13/2017 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103AA03800 Jurisdiction: Tigard Site address: 12295 SW 106TH DR Project: Crawford Subdivision: CLYDESDALE Lot: 20 Project Description: Irrigation backflow. Contractor: CRAWFORD, SEAN Owner: CRAWFORD, SEAN H 12295 SW 106TH DR 12295 SW 106TH DR TIGARD, OR 97223 TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 06/13/2017 $31.27 Specifics: 1 12%State Surcharge- 06/13/2017 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 06/13/2017 $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 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 JL!_ 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. liECEIVEPPlumbing Permit Applicatio Building Fixturesf FOR OFFICE USE (NLI ,1 U N 9 2017 Received City of Tigard ��1 DateBy (//2//7 - Permit No L_/`l, 1/?�©a23 2 11,..._ III 13125 SW Hall Blvd.,Tigard,OR 91031 ' r! ARD P Review $, x �'._ Other Permit No ■., Phone: 503.718.2439. Fax 503.59 .1960 Date/By: � �`t} Inspection Line: 503.639.4175 � � t� �DIVISIONDate Ready/By: Juris: El See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information JIOF ww FEE t{ V __ *;S : h4 . . _ . _ Demolition For special information use checklist ®New construction 0 Description I'Qty. I Ea. I Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) " ` vWOJCfiltY t ( sT : A . _ ,, _ } 4 SFR(1)bath 31270, ` SFR ® 1-and 2-family dwelling 0 Commercial/industrial (2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SI I;E-INFOBMpl 4ND l OCATI9N ._ Site utilities: Catch basin or area drain 18.76 Job site address:12295 SW 106"Dr Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard/OR/97223 Footing dram(no,linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name:Sprinkler System Manufactured home utilities 50.03 Cross street/directions to job site:SW 106"'Dr and SW Tiedeman Ave Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 1 31.27 31.27 Backwater valve 12.51 iIE$CIilTIbAt OF WORK': __ Clothes washer 25.02 Installing anti-siphon/backflow preventer valves for sprinkler system Dishwasher 25.02 Installing on current outdoor water spigot Drinking fountain 25.02 Ejectors/sump 25.02 , Expansion tank 12.51 x�4RQPTYtTY Ol?V19ER.. .. -�;� 1�:T'EI�ANT Fixture/sewer cap 25.02 Name:Sean Crawford Floor drain/floor sink/hub 25.02 Address:12295 SW 106th Dr Garbage disposal 25.02 City/State/ZIP:Tigard/OR/97223 Hose bib 25.02 Phone:(503)754-5636 Fax ( ) Ice maker 12.51 181 APPL1trAN`I'. . 0CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: 12.51 Primer Contact name:Same as above Roof dram(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail:crawfsea®gmail.com Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: �) L/ivi L--k-, Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Minimum permit fee: $72.50 22_$'p Phone:( ) Fax:( ) Plan review (25%of permit fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) c.f, 70 Authorized signature: �� TOTAL PERMIT FEE P%Ze' Date:6/7/17 This permit application expires if a permit is not obtained within 180 days Print name:Sean Crawford after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:1BuldingWermits\PLMU-Pere itApp.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: Siteutilities' . ±2 t � ''TQtat_ Square Fo`otag+e' '` 'etu 'ee. Footing drain-1'100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 `' 2,001 to 3,600 $169.69 Sewer-1st 100' 3,601 to 7,200 $233.20 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 t ; Storm&Rain Drain-1st 100' 62.54 alua �Il� e: $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$1.52 for Qtll l' IS 1ect1011$eor-Fees-_ Qty ee en) Total each additional$100.00 or fraction thereof,to 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*. laln Revl<ewolumbling XnsaUat�qus Work a pane Replace? Plan review is required for of the following. Work Performed:; Capped Added- Relarateany 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 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic 0 Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit a sets of plans with any of the above. -3" Car Wash Drain Some (ric or Ri e)Ct� Slgll' A� Garbage -Domestic-non-food LJ 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 *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 Urinal plumbing permit can be issued. Other Fixtures: C:\Users\sean.crawford.AGILYX\Desktop\PLMF PermitApp.doc 2 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12295 SW 106TH DR, TIGARD, OR, 97223 Record Type: Record ID: Residential - Plumbing PLM2017-00232 Inspection Type: Inspector: 399 Plumbing final Don Sylvester Result: PASS - NoCofO Comments: 1 . 3/4" Wilkins PVB, model 720A, serial# CB223412 , for irrigation, located at left side of garage - ok with test Violation Summary: Inspector Contractor