Permit CITY OF TIGARD PLUMBING PERMIT
„" Permit#: PLM2017-00343
COMMUNITY DEVELOPMENT
Date Issued: 08/24/2017
-Fr G .kt D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111DD02200
Jurisdiction: Tigard
Site address: 15680 SW 88TH AVE
Project: Connolly Subdivision: STRATFORD Lot: 36
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: OWNER Owner: CONNOLLY, JON&KAREN
JON CONNOLLY 15680 SW 88TH AVE
15680 SW 88TH AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-891-9874 PHONE: 503-891 9874
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/24/2017 $31.27
Specifics: 1 12%State Surcharge- 08/24/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/24/2017 $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, n if w k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Util" otification Cen - Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules
direct questions to OUNC calla,g 503.232.1987 or 1.800.332.2344.
Issued By: diLPermittee Signature:
_,,,,,
\ / Call 503.639.4175 by 7:00 a.m.for the next available inspection da .
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 c, �,, .4 /��,
City of Tigard Received ,,-/ [��
�J g �Cf /7 x
Permit L���7(50 3V
lim 13125 SW Hall Blvd.,Tigard,OR 972A31{� 9 4 2 n a Plan Re: ( �"
_ §� i i_I_ I' Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit No.:
l I G A R D Inspection Line: 503.639.4175 rs..; f`A i�-, Ill �;- i-, Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov -•-, 1 ,_e;. A t r'q &,8 Notified/Method: Supplemental Information
TYPE OF t ,1 1N ia
i OjY1 jQ FEET`SCIHEDWi -
❑New construction 0 Demolition For special information use checklist.
Description Qty. I Ea. I Total
❑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
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION"AND LOCATION Site utilities:
Job site address: '✓6 10 ! Ctg# A Catch basin or area drain 18.76
l !� kDrywell,leach line,or trench drain 18.76
City/State/ZIP: �i-i 4,Ar-or 69, qi'7� 21
f,g Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: . ./ori-n G/G� 5 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
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer )i 31.27 4/,a'7
DE _ ti JON .P, itIC 5' ;; Backwater valve ` 12.51
, ` `"4. P : Clothes washer 25.02
`('ce-e' Q- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
p,PROI'ERTY OWNER I ❑ithv,ANT 4, Expansion tank 12.51
Name: ton Fixture/sewer cap 25.02
'�'�01/1 7j� �-r Floor drain/floor sink/hub 25.02
( D
Address: 5 1 ' �r Of,
I l S I hF �'� �---f Garbage disposal 25.02
--n-4City/State/ZIP: - -g - , ofe. 17Pl fr Hose bib 25.02
Phone:( j)) 9,ci1.- q0-71 Fax:( T) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON ,,:. Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(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
E-mail: Urinal 25.02
.--' - - Water closet 25.02
CONTRACTOR ,
Water heater 37.52
Business name: t l(A'(0 //) _ Waterpiping/DWV 56.29
Address: Y Other: 25.02
City/State/ZIP: Subtotal 3l.y7
Phone:( ) / Fax:( ) Minimum permit fee: $72.50 `7a,
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee) �.7
Authorized signature: ' ._ TOTAL PERMIT FEE El,a-o
�// Date: This permit application expires if a permit is not obtained within 180 days
Print name:
JG✓1 •✓1 Yt O//7 6,-
after it has been accepted as complete.
/ *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 Qty. Feet a) Total ' Square Footage: Permit Fee:
Footing drain-1St 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 $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Vola$ Permit Fee:
Storm&Rain Drain-1st 100' 62.54 Il:
$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
Other Ins ections or Fees Qt' Fee(ea) Total each additional$100.00 or fraction thereof,to
p 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*. Plan Review for Plumbing Installations
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
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
-Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
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
Ice Mach./Refrig.Drains Comments regarding fixture work:
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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
DPW*. .
Backflow
BACKFLOW EXISTING C REMOVED
PREVENT=REPORT H
' ' [ REPLACED
REPAIRED OLD SIN:
PROPERTY NAME Karen Connelly MOM 503-422-9874
CONTACT NAME PHONE
MADAM ADDRESS 10015 SW Highland Dr
crn Tigard STATE OR z6• 97224
PREVENTERADDRESS 15680 SW 88th Ave Tigard,� OR9s4378926
WATERSUPPTR Tigard �
LOCATION Back of Property by street
MAKE Watts MODEL. 007 M3 fuzz 3/4"
TYPE ❑RP 0 RPDA 0 RPDA-II ®DC❑DCDA ❑DCDA-E ❑PIM ❑SVR ❑AVB ❑AO
HAZARD PROTECTED 0 PRESESES1SOLATION❑IRRIGATION❑IDtESYSIBI ❑BOIL[i= Li omitit
APPROVED:❑ASSEMBLY 0 DISYAGLATION❑ORtIMAIIO( 0 Alit0AP reams in in
REDUCED PRESSURE ASSEMBLY PVRAISVBA INITIAL TEST
DOUBLE CHECK AIR INLET CHECK VALVE PASSED DTKI
CHEEK et CRECYMI TYPED❑ IP9mAT Pasrst et
Patin TIGHT ® RAILED 0
ORM
INITIAL WINS/RIO 2.1
TEST KELIRP VALVE LEAKED ❑ .r in iwerto MR rAD DATE 08-24-17
RESULTS _ OFEMD
orareowT: tun mem CR6(7CFS FOLLY ❑ FAKED SYSTEM PSI 86
RELIEF V VE.: MONT ® 1.6 �❑ DEFECTOR METER
MIND FARM 11:1
LEA KED ❑ sM/Rml
•
NOTES
REPAIRS
PARTS
REDUCED PRESSURE ASSISIIIILY TEST
CHECK VI DOUBLE CHECK AFTER REPAIRS
DIM CHECK TYPE II❑ AIR BEET CHECK VALVE
REPAIR rum SPu MDT 0 MEWED AT: PRIM MAP:
RESULTS RRL=VANE DATE
OPENED AR (HE(;KIZ 5 M MID MNIPIM MIT!®
I VALva wu+2Pan IKEST ❑ �❑ PASSED ❑
PA51ZD❑ MUM ❑ IMltam
GAUGE SIN 02143098 MAKIMODICLMAX MidWest 845-5 CALDERA/ION DATE 07-31-17
In completing and submitting ibistestmpot the testes acetifies Ent the✓ was tested end a in scoordanco with allin seeotelsone with all applicable
mks,tame,codes amt regadalioes oIthe Mate and water system taros spenmeed taping equip and approved testing procedures.
INITIAL TEST TEST AFTER REPAIRS
1fy^ � 6422
1 ffi ,GNAIURE TESTER STONAIIRE TESTER CERT Si
Steve Reid 503-491-9402
503-491-9402
15685THUM W 116th Ave 199 Portland,OR 97224 steveaoPHb IC Com
TEsiER ADDRESS IE47YA Mrs= EMAIL
Oregon Backflow Testing, LLC ®WATER RESTORED?
COMPANY NAME- COMPANY NAME
a FOUND OFF,LEFT OFF .
aaporrRP.®YEDBYattint WFAOVROPOWNIR) aWGNrRW vEOBTRI@BEErIAmEO OWNER)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15680 SW 88TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2017-00343
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 3/4" watts D.C., model 007M3, serial # 378926, for irrigation, located by water meter, -
ok with test.
2. Note: protect device from freezing
Violation Summary:
Inspector Contractor