Permit (116) CITY OF TIGARD PLUMBING PERMIT
sill COMMUNITY DEVELOPMENT Permit#: PLM2017-00495
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/11/2017
Parcel: 2S114AA00100
Jurisdiction: Tigard
Site address: 8680 SW DURHAM RD
Project: Tigard Aquatic Center Subdivision: None Lot: None
Project Description: Replace 1"backflow device
Contractor: DETEMPLE COMPANY INC Owner: TIGARD-TUALATIN SCHOOL DISTRICT
5636 NE HASSALO STREET 6960 SW SANDBURG ST
PORTLAND, OR 97213 TIGARD, OR 97223
PHONE: 503-227-2641 PHONE:
FAX: 503-274-7686
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/01/2017 $31.27
Specifics: 1 12%State Surcharge- 12/01/2017 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 12/01/2017 $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 OUNCby calling 503.232.1987 or 1.800.332.2344.
Issued By KO12/77kri_e____ Permittee Signature: RAif p 69_770
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 1- p 1icati � IVED
BuildingFixtures { < r z 6 t t
fi ��t ,a ' FOR OFFICE USE ONLY '
�C � �� Received
,�ua, �,(�j�at(��:.a--. ��� �y."���j
X11! O H Bh ���� 017 .:45Zr ermit NoP/it o,7 C�G� /
1 +s l 3125 SW Hall Blvd.,"Tigard,OR 97223 t)atetBp` ������/
: .� Plan Review
Phone: 503 718 2439 Fax 503._ �`O (_ i
Inspection Lane: 503 639 4175 d T ° " Date By' Other Permit Na.:
rT I G A RDS p mte head/B urn: 0 See Page 2 for Internet www.tigard-or.gov yet DIVISION
�) ,{��q Ready/By: Z )/" s g
' - 1�I-1.1-G-DTVI 9ION Notifiedimeth - Supplemental Information
._ _ TYPE Or WORK :.ti. ZiAiet/TEFF SChTEDULE
0 New construction 0 Demolition for special information use checktisx
Description Qty. Ea. Teta!
®Addition/alterationlreplacemcnt 0 Other: __
New l-2-fanzi1 davcIhzzgs(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath ( 312.70
❑ 1-and 2-family dwelling i4 Commercial/industrial SFR(2)bath 437.78
SFR3 bath
❑Accessory building 0 Multi-family (') 500.32
-` •
- Each additional bath/kitchen 25,02
❑Master builder 0 Other:
__. Fire;spunkier( sq.Il.) Page 2 -_
JOB SITE'INFORMATION .NT) LOCATION _Site utilities:
Job site address:8680 SW Durham Rd I Catch basin or area dram 18.76
.
_._. Drywell,leach line,or trench drain18.76
City/State/ZIP:Tigard,OR 97224
1 I.
_ Footing drain(no.linear ft:__-.._) I Page 2 '
Suite/bidg./apt.no.: Project name:Tigard Swim Center Manufactured home utilities 50.03 I
Cross street/directions to job site: Manholes 1 18,76
Rain drain connector 18.76
Sanitary sewer(no,linear ft.: ) I Page 2
I _ Storm sewer(no.linear ft.: ) I j Page 2 ._W _
Water service(no.linear ft.: _) J� Page 2
Subdivision: Lot no.: ___
. Fixture or item:
Tax map/parcel no.: Backflow prcventea- } 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
I replace failed 1"backflow device Clothes washer 25.02
_._ot. _ _
Dishwasher 25.02
Drinking fountain 25.02
Ejeetors/sump 25.02 i
❑ PROPER'T'Y OWNER 0 TENANT Expansion tank 12.51
1
Name: Fixture/seweer cap 25.(}2
-- .W - Floor drain/floor sink/hub t 25.02
Address: .
Garbage disposal 25.02
City/State/ZIP:
_ _- - __.__ ___..
Hose bib 25.02
Phone:( ) Fax:( ) -- Ile maker 12.51
G APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:DeTeznple Co Medical gas(value:$ ) Page?.
Primer �� 12.51
Contact name:Suzanne Postula ._ ,_____._.
- . Roof draincommercial
Address:5636 NE Hassalo St ) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:Portland,Or 97213
_._. Solar units(potable water) 62.54
Phone:(503)471-5267 Fax::(503)274-7686 Tub/shower/shower pan 12,51
1 E-mail:s.postula@msn.com Urinal 25,02
.. water closet
CONTRACTOR 25.02 1
-- -- Water heater
Business name:DeTemple 37.52
__..._- -..__._.._...-_ . WaterpipingiDWV 56.29
Address:5636 NE Idassalo St _ _ Other: 25.02
l
1, City/State/ZIP:Portland,OR 97213 t Subtotal 31.27
Phone:(503)471-5267 Fax:(503)274-7686 Minimum permit fee: $72.50 72.50
CCB Lie.:2510 Plumbing Lie,no.:26-25PB Plan review (25%of permit tee)
_.ti / State surcharge(12%of pemit fee) 8.70
Authorized signature: �i ,r7G 1 ftf �r 1, Lt -{,6.-."' TOTAL PERMIT FEL ; 8f.20
Tint name:Suzanne Postula Date: 11/29/2017 This permit application expires if a permit Is not obtained uithln 180 days
t___
- after it has been accepted as complete.
*fee methodology set by id-County Building Industry Service Board.
I.i3011ding Permit::PI M11-PemsitApp.doc 11 Si 09 440-16161'110 02(*OM wilts)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8680 SW DURHAM RD, TIGARD, OR, 97224 December 12, 2017 at
2:38:02 PM
Record Type: Record ID:
Commercial - Plumbing PLM2017-00495
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " backflow device model watts Ser#120846 approved with test report.
Violation Summary:
Inspector Contractor