Permit (57) „Ia CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00344
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2017
Parcel: 2S103CA00101
Jurisdiction: Tigard
Site address: 13185 SW 115TH AVE
Project: BCS Batiment LLC Subdivision: None Lot: None
Project Description: Irrigation backflow.
Contractor: H&H MECHANICAL Owner: BCS BATIMENT LLC
5757 SE WILLOW LN SKYTERA LLC
MILWAUKIE, OR 97267 19705 SW 65TH AVE
TUALATIN, OR 97062
PHONE: 503-975-9787 PHONE: 541 337-8306
FAX: 503-659-2979
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/28/2017 $31.27
Specifics: 1 12%State Surcharge- 08/28/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/28/2017 $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.
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Issued By: .2 / Permittee Signature: 4,,
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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.
1
Plumbing Permit Application
BuildingFixtures ' . i
FOR OFFICE USE 01L1
A +.
City of Tigard ! ,rReceived V� O/7 ,iv,,,,, Permit No/OL/
tf "7-1503,9y4
lig '11 13125 SW Hall Blvd.,Tigard,OR 97223 4 . Flan Review _
Phone: 503.718.2439 Fax: 503.598.196 i`r /u!I Other Permit N '1...-y� 1
l)t� Date/By: .. S/p �/ G'oQ3J
T I G A R D Inspection Line: 503.639,4175 Date ReadyBy: Juris: Ea See Page 2 for
Internet: www.tigard-or.gov ot A 1 3 Noti led/Method.4041 f/ Supplemental Information
TYPE OF WOR f
it}7L ` {7Z IN FEE* SCHEDULE
❑New construction I.VeliO } For special information use checklist
Description I 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
El 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:13185 SW 115th Ave Catch basin or area drain 18.76
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.: I Project name:115th Addition Manufactured home utilities 50.03
Cross street/directions to job site:SW Fonner St 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: J Lot no.:110 Fixture or item:
Tax map/parcel no.:2s-lw-03-sw-ne Backflow preventer 1 31.27 31.27
DESCRIP I ION OF� ORi Backwater valve 12.51
Clothes washer 25.02
install of backflow preventor for new sprinkler system Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
kg PROPERTY OWNER J 0 TENANT Expansion tank 12.51
Name:BCS Development LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:19705 SW 65th Ave
Garbage disposal 25.02
City/State/ZIP:Tualatin,OR 97062 Hose bib 25.02
Phone:(541)337-8306 Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: f( /";fit M+ -}' Medical gas(value:$ ) Page 2
COI
II smthA Primer 12.51
Contact name: l-4�
�y� `� Roof drain(commercial) 12.51
Address: 1q� ` 'elft\� �l ' Sink/basin/lavatory 25.02
l
City/State/ZIP: /(a 0i2 t' �l-J.
I1) Solar units(potable water) 62.54
Phone: ( )a3�7-63 4)/
Fax::( ) Tub/shower/shower pan 12.51
E-mail:V(*),;-With
n'�'-,„ mi r Urinal 25.02
CO CiOR Water closet 25.02
Water heater 37.52
Business name:• 4 ti10-PGh I 9�f(C L.,/, Water piping/DWV 56.29
Address: , ilia, 4. Other: 25.02
City/State/ZIP: f U l J�/ ! [i j Q ' ' #7 Subtotal
Phone: Q3 ) 9 --.976-7 Fax:( ) Minimum permit fee: $72.50
9
22_ Plan review (25%of permit fee)
CCB Lic.: f-7 ..)1� Plumbing Lic.no.: f /
-
�, State surcharge(12%of permit fee)
Authorized signature' / „di, •-"
TOTAL PERMIT FEE
Print name: Cyb / !/1e /1 ! g 1-7 This permit application expires if a permit is not obtained within 180 days
�l d �J 1/` '�= Date: /� �( after it has been accepted as complete.
'd / CLS , /l d' "t-221" h Fee methodology set by Tri-County Building Industry Service Board
\ .
1.\Building\PermitsPL -'ermitApp.doc 10111099 (/6 440-4616T(l0/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223 December 6, 2017 at
9:46:56 AM
Record Type: Record ID:
Residential - Plumbing PLM2017-00344
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Provide approved test report for backwater devise.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13185 SW 115TH AVE, TIGARD, OR, 97223 December 11 , 2017 at
1 :37:42 PM
Record Type: Record ID:
Residential - Plumbing PLM2017-00344
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
1 " Wilkins model 350, serial number A638964.
Violation Summary:
Inspector Contractor