Permit (179) CITY OF TIGARD PLUMBING PERMIT
it: ` COMMUNITY DEVELOPMENT Permit#: PLM2017-00496
T[ ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/04/2017
Parcel: 2S111 BC00500
Jurisdiction: Tigard
Site address: 10055 SW INEZ ST
Project: GRADIN Subdivision: TIGARDVILLE HEIGHTS Lot: 19
Project Description: Backflow preventer for irrigation.
Contractor: WESTWOOD HOMES LLC Owner: GRADIN, DANIEL L&SALLY K
12700 NW CORNELL RD 10055 SW INEZ ST
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503-330-2215 PHONE:
FAX: 503-342-2403
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/04/2017 $31.27
Specifics: 1 12%State Surcharge- 12/04/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 12/04/2017 $41.23
Plumbing
Class of Work: ALT
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 they 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: ' Permittee Signatur
. c
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
City of Tigard Received ^� Permit No.: nf� G
Date/By: 41/1 i / i- Pl�'1 t�Ot 7.c Ll l!n
INU 13125 SW Hall Blvd.,Tigard,OR 97223 v,�C P"�, �� plan Review
Phone: 503.718.2439 Fax: 503.59 ®"4 Other Permit No.:
Inspection Line: 503.639.4175 F Date/By:
T 1 G A R D 1! Date Ready/By: Juns: See Page 2 for
1l �^�
Internet: www.tigard-or.gov C Notified/Method: 1-X6 Supplemental Information
TYPE OF WORK G ,, FEE* StREDULE
0 New construction ❑I7�e i li1'10QV- 111,,4 x tt For special information use checklist
,�''``��
rill.At.:: Description Qty. I Ea. I Total
j2tAddition/alteration/replacement ❑51h +:• New 1-2-family dwellings(includes 100 ft.for each utility connection)
' CATEGORY O CONSTRUCTION SFR(1)bath 312.70
121-and 2-family dwelling 0Commercial/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: /69a 5 - Sv i7i't ((j i Catch basin or area drain 18.76
City/State/ZIP: �� r( Drywell,leach line,or trench drain 18.76
/t 4' Z / ( /�. Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: / Project name: /
Cj{2'A.1j.v 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 / 31.27 3i '7
-° ,,w Backwater valve 12.51
DE:;� ON
ORK
/� Clothes washer 25.02
(rng‘tt61 C?(//. 1 1Dishwasher 25.02
v ge/ii4t
Drinking fountain 25.02
Ejectors/sump 25.02
i PROPERTY OWNE 3 0 TENANT Expansion tank 12.51
Name: girt g/ /� � �r7���� Fixture/sewer cap 25.02
"] v "`��� (,il 11 � Floor drain/floor sink/hub 25.02
Address: � ,/,,tiie /� Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
�,+-� it> ��44- t 1Aii Primer 12.51
Contact name: C�7C i ' ]�,
Roof drain(commercial) 12.51
Address: /Vine) f�'� / -' l/ Sink/basin/lavatory 25.02
City/State/ZIP: r,/ tyf /`� Solar units(potable water) 62.54
Phone:(V3 ) 62/e: Fax::( ) Tub/shower/shower pan 12.51
E-mail: i / , ,.fr � Atte- 1 y yf ,1,-- it Urinal 25.02
ll C 4; �"r,N.- Water closet 25.02
ONTR CTOR
- - Water heater 37.52
Business name: _ q/ '7 ,lv e !� gee-re Water piping/DWV 56.29
Address: (J�[ ��L ed
Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 -7,z-$11
Plan review (25%of permit fee)
CCB Lic.: ;iii Plumbing Lic.no.:
I State surcharge(12%of permit fee) k„.-70
Authorized signature: i r TOTAL PERMIT FEE 3),}-v
Print name: `7 c Date:
/L it.
This permit application expires if a permit is not obtained within 180 days
l 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 QV- Fee(ea) Total Squ r outage• Perndt Fec:
Footing drain-151 100' 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 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
Other Ins ect 0s, or Fees Qty. {ea) I°, ' and includingil 0 or fraction thereof,to
h and $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 ❑ 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 ior Riser Diagram -;
4" ❑ 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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10055 SW INEZ ST, TIGARD, OR, 97224 December 26, 2017 at
7:30:39 AM
Record Type: Record ID:
Residential - Plumbing PLM2017-00496
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
Test report received.
1 " febco model 850, serial number HE48371 located right side of drive by water meter.
Violation Summary:
Inspector Contractor