Permit CITY OF TIGARD PLUMBING PERMIT
N ' COMMUNITY DEVELOPMENT Permit#: PLM2018-00154
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/04/2018
T f ' P° g Parcel: 2S 111 DA22800
Jurisdiction: Tigard
Site address: 15535 SW APPLEWOOD LN
Project: LAYMAN Subdivision: HERITAGE CROSSING Lot: 47
Project Description: Backflow preventer for irrigation.
Contractor: TERRA-SOL LANDSCAPING Owner: LAYMAN, DONALD C&SOPHIE
21685 SW HEDGES DR 15535 SW APPLEWOOD LN
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503-691-6105 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/04/2018 $31.27
Specifics: 1 12%State Surcharge- 04/04/2018 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 04/04/2018 $41.23
Type of Use: SF 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 01 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 requirgs--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'
OUNC by calling503.232.1987 or -.:. 44. �f /
Issued By: /� / Permittee Signature: ` AZ--NN
-S
Call 603.639.4175 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 co - , of the project.
Approved plans are required on the job site at the time of each inspection.
IIIllfr
Plumbing Permit Application i� .
'
Site Utilities t ; t FOR OFFICE USE ONLY
3
h fa, Received ii Permit No.: r'c�!�i
ili City of Tigard ? °t Date/By: ti
l t /�
u 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit No
a Phone: 503.718.2439 Fax: 503.598.1960 N?, ..w.,=0,.''',' Date/By:
Inspection Line 503 639 4175 t gie Ready/By: Iuns gea Information
SeePa 2
I I C \R D " btifie ethod. Suppleme 1
Internet: www.tigard-or.gov '� �� � t� ���^
"Miv�t��N�`' $Wg � � K�� jr�§ sae �` -"�«� -:��ra�"�f"c€ "` 3„A
For special information use checklist
❑New construction 0 0 :Iition Description l Qty. I Ea. I Total
aAddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
s gift: SFR(1)bath 312.70
.O :,. , m,, n.., ,. - SFR(2)bath 437.78
q1-and 2-family dwelling ❑Commercial/industrial SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
W , f i° 1 s , 1_ 4 91 t o Site utilities:
. � :�� ' �- f Catch basin or area drain 18.76
Job site address: I5 c-n' S W k�: `Q�} LA, 1 Drywell,leach line,or trench drain 18.76
City/State/ZIP: I- q cts-A "anti Footing drain(no.linear ft.:_) Page 2
J �
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03
Manholes 18.76
Cross street/directions to job site: 18.76
Rain drain connector
Sanitary sewer(no.linear ft.:__) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: l Lot no.: Fixture or item:
Backflow preventer i 31.27 31,2,-4'
Tax map/parcel no Backwater valve 12.51
f. i �i tai� ' .. o .k.,. .. Clothes washer 25.02
. .��- ,_�Y.�t;t` ,: .� ...�� . � � � q - 25.02
{2.(',l(,,it-7,:t.:'A - ( N (L 1 Dishwasher
Drinking fountain 25.02
■ Ejectors/sump 25.02
4 4.: 12.51
- ;f f t �# , ; Expansion tank
got -.ate i, r a"e�g 25.02
t Fixture/sewer cap
Name: `rye"\ �_ i' v\ l� L\ Floor drain/floor sink/hub 25.02
Address: k;i'*r-L Garbage disposal 25.02
GtyJState/ZIP
Hose bib 25.02
( Agtv Ice maker 12.51
Phone:(C.31 71) ,) t��- Fax )
ilan # 8 a a,` wwa Interceptor/grease trap 25.02
IZA �u ) Page 2
a: .H.ix1� _ ,. Medical gas(value:$
Business name: I'm-f Q, So\ yy,aSe i VIt Primer 12.51
Contact name: �Q (, A, 7.:,Yh N\ QJ'(( rvtr�y\ Roof drain(commercial) 12.51
Address: fX,\
1 5 [c�-N" _ Sink/basin/lavatory 25.02
� C1/1.70(0')--
�.,1 -
(11. /`vl., -' Solar units(potable water) 62.54
City/State/ZIP: ��� � V� V lJt[J
! Fax. .(50`) R- -C1 ki 1+ Tub/shower/showerpan
12.51
Phone:�-,o� ) (7 (�5 I Urinal 25.02
r25.02
E-mail
be�ra. S O ! t (l f `C
fgaci Water closet
- w p � 37.52
Water heater
Business name: / ' Water piping/DWV 56.29
`��.. e.%,,..5ri�h�1/'� 25.02
Other:
Address: Subtotal
City/State/ZIP: Minimum permit fee: $72.50 4,..50
Phone: ( ) Fax:( ) - Plan review (25%of permit fee)
CCB Lie.: : . - 1. Plumbing Lic.no.: State surcharge(12%of permit fee) 1, -L?
TOTAL PERMIT FEE k').
Authorized si.nature: ��
This permit application expires if a permit is not obtained within 80 days
Print name: ! 0- 6 1/� Date: I after it has been accepted as complete.
0. 1 *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 Tigard111111
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems
!"'1 @ ,- - ``" ; ' -Z' -�'�, ,'a.ate^-.l 4:-;',=';'0'P::.::::? _.e'x as'" § '€ . 3 ', .
Footing drain-1'100' 1_ ..4 r �a -
50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
Sewer-each additional 100' 7,201 and greater $327.54
37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' Medical Gas Systems:
37.52
Storm&Rain Drain-1st 100' 62.54 <. _ Ag` -„, -
Storm&Rain Drain-each additional 100' $1.00 to$5,000.00 Minimum fee$72.50
37 52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
� � Mfr fes - ' each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.00.
$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
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including$25,000.00.
hours(minimum charge-2 hours) $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/1u
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*.
Ii' y}! �fi � ,A ma,. '- .
k=f`� Vi , _ Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher Commercial El Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain sink 2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain Lra � ` =i
.�_:
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
C:\Users\TERRA-.1\AppData\Local\Temp\PLMU_PermitApp.doe 2
IIIn Site Utilities — Plumbing Permit Application
e al
Plan Submittal Requirements
TI( ARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map&tax lot# El project name ❑ site address ❑ suite number
El zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS -Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Permits\PLMF-PermitApp.doc 12/30/05
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15535 SW APPLEWOOD LN, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2018-00154
Inspection Type: Inspector:
399 Plumbing final Jeff Grove
Result:
PASS - NoCofO
Comments:
Backflow report received
Violation Summary:
Inspector Contractor