Permit (71) CITY OF TIGARD PLUMBING PERMIT
a 2. COMMUNITY DEVELOPMENT Permit#: PLM2017-00537
T r GAR. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/27/2017
Parcel: 2S111AA11500
Jurisdiction: Tigard
Site address: 14405 SW 90TH AVE
Project: Greensward South, Lot 9 Subdivision: GREENSWARD SOUTH Lot: 9
Project Description: Backflow preventer for irrigation.
Contractor: AUSTIN BROWN LANDSCAPE Owner: GP4 LLC
PO BOX 14441 PO BOX 1577
PORTLAND, OR 97293 BEAVERTON, OR 97075
PHONE: 503-887-7795 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/27/2017 $31.27
Specifics: 1 12%State Surcharge- 12/27/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 12/27/2017 $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 rule adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m. obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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 comple on of e project.
Approved plans are required on the job site at the time of each inspectio
Plumbing Permit Application
Building Fixtures
City of Tigard ,:t.i..„,,,,.t 0...,, I, zi 1„.., DR ea ctee/iBv eyd I) #1...,-/
i 7 ig-1.7.-- Permit No.:ifroi/ra 7-c ,s-3
.1 13125 SW Hall Blvd.,Tigard,OR197A3
:.' Plan Review
503.718.2439 .598 ..196¢e 2.(61.7
III
I Phone: Fax: 503
Date/By: Other Permit NopelT02Lli 7--CCA li 7
n‘ i, 0
TIGARD Inspection Line: 503.639.4175 ,,,. , ,. 1., Date Ready/By: Juns• gi See Page 2 for
Internet: www.tigard-or.gov i i i. -2 rt r-,,,-.t, Notified/Method: Trt1;0 Supplemental Information
TYPE OF WO . 1.1 *‘,1 i o‘Vibll01- ' SCHEDULE
"Mr ..,...,
..• ew construction 11 Demolition For special information use checklist.
Description Qty. Ea. 1 Total
0 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
0-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SIT E INFOHNTION AND LOCATION -, Site utilities:
_.,
18.76
Job site address: t-ilA1-1 vr)c Catch basin or area drain
Drywell,leach line,or trench drain 18.76
City/State/Z1P: 'Tif\ i° Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:
Manufactured home utilities 50.03
Cross street/directions to job site:
# i. L)‘\ ( k - 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: a /:,. . ., s, I Lot no.: C:7 Fixture or item:
Tax map/parcel no.: Backflow preventer
( 31.27 f
Backwater valve
i)iSelHIHICT OF WORK Clothes washer 12.51
25.02
e--t '4.-72.1-t,' -,-"r- - S.64v
11'14 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
iltokitTy iswNiii ,,,,, „ ,,, C] TEjaNt.,‘„0,,, ,a,:p .., Expansion tank 12.51
Name.
• F(54 g--- 0 Cel3S7 kti(C--7(6) Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
Interceptor/grease trap 25.02
0 APIFIACiOIT ''' 7' " '' 0 CONTACT PERSON,,
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
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTORWater heater
37.52
Business name: kA.57 gj 1 Ajt,,im (.......A.kw/Ar-6\
Water piping/DWV 56.29
Address: f 6 ,e4 Other: 25.02
City/State/ZIP: dy:t(..liv , 7 - )ii ANN Subtotal j),i....7
Phone:K-74) f.f-3- '7?-7 .------- Fax:( ) Minimum permit fee: $72.50
CCB Lie.: Plumbing Lic,no.: q2-€ (9 1Plan review (25%of permit fee)
. -
State surcharge(12%of permit fee) 7:-7ti
Authorized signature:
TOTAL PERMIT FEE I.)-6
Print name: 4;-- (d g Date: ( ) T- This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennits\PLMU-PernutA•..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:
(
Qty. Fee(ea) .,; Total Squire Footage ;
Site Utilities q Permit Pee:>
Footing drain-1s'100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 Feet
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
y Fe`i�ca) 3 Vital each additional$100.00 or fraction thereof,to
Other Inspections or Fees .x • 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*. Wan Re e*for'Plumbiftglfistalla on
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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3" Isometric ;1r Riser 1'101
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
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:
14405 SW 90TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2017-00537
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Wilkins backflow assembly model 350 ser#A639688 approved with test report
Violation Summary:
Inspector Contractor