Permit CITY OF TIGARD PLUMBING PERMIT
II 'i COMMUNITY DEVELOPMENT Permit#: PLM2018-00162
T 1 C;A lr 1.1, 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2018
Parcel: 2S106DB11000
Jurisdiction: Tigard
Site address: 17363 SW AMELIA ST •
Project: Schmidt Subdivision: RIVER TERRACE NORTHWEST Lot: 110
Project Description: Installing backflow preventer for landscape irrigation.
Contractor: JOHN DARBY LANDSCAPE INC Owner: SCHMIDT, GEORGE JACOB&ELIZABET
13867 SW BENCHVIEW TERRACE 17363 SW AMELIA ST
TIGARD, OR 97223 BEAVERTON, OR 97007
PHONE: 503-579-5298 PHONE: 303-803-8142
FAX: 503-524-6613
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/12/2018 $31.27
Specifics: 1 12%State Surcharge- 04/12/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/12/2018 $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.
Issued By: Permittee Signature:
"_.".
Call 503.639.4175 by 7:00 a.m.for the next available insp- tion date.
This permit card shall be kept in a conspicuous place on the job site unt completion of the project.
Approved plans are required on the job site at the time of each inspection.
i1
Plumbing Permit Application .,,�,4
Building Fixtures FOR OFFICE USE ONI.
City of Tigard • r i Received (2.--//r/4.1\--
�� i��
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: /� Permit Noy
)1 ,4 Phone: 503.718.2439 Fax: 503.598.1960 ?Dde/By:ewy / " �L/1,..c24,24,5.-1:2976,,,,2
`� `��
Inspection Line: 503.639.4175 �Dyya,tgqe/By: Other Permit No.:
TIGARD p � �9le Bad B
Internet: www.tigard-or.gov Y yd Juris: I Supplemental
See Page 2 for
Notified/Method:
Supplemental Information
TYPE OF WORK FEE* SCHEDULE
AlNew construction t- ,
For special information use checklist
❑Addition/alteration/replacement _ Description Qty. Ea. Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
, `, < tCATEGORI' OF CONSTRUCTION , 4 ' SFR(1)bath 312.70
SFR(2)bath 437.78 I
y 1-and 2-family dwelling 0 Commercial/industrial
0 Accessory building ❑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: 11 S V '. ��.4 Catch basin or area drain
18.76
dean e_\
City/State/ZIP: cz�eV v. 0I C(70(5-7
Drywell,leach line,or trench drain 18.76 l
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:
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Subdivision: Water service(no.linear ft.: ) Page 2
K.UC v" 1y'C"ctCt Lot no.: Fixture or item:
Tax map/parcel no.:
Backflow preventer 31.27
i . ' - . ;:, 7 .;.,pESCRIP'tION )F O r 42 'ii t , ; � ,:. Backwater valve 12.51
�� '"' Clothes washer
Y t '1C\let:" C` '4 9 �c- 25.02
Dishwasher 25.02
Drinking fountain 25.02
�, ',,,, Re-04...
, Ejectors/sump 25.02
® , r 9 R 4.. 4', .,1,4' 0"TEN I I "$ ..,,., Expansion tank 12.51
Name: e .4-41,,,,,_ kA t t sL._t :I j4-
Fixture/sewer cap 25.02
Address: i ") - Floor drain/floor sink/hub 25.02
f--t---0 Garbage disposal 25.02
City/State/ZIP:
c.0e - CICZ6 7
Phone:(303 )3 •-F Hose bib 25.022
'' �; i Fax:( )g,, � . _ Ice maker 12.51
p ! 4ICAr ,. F � ❑'cat:A±CT,PERM N Interceptor/grease trap 25.02
Business name: ,0 ei I r,, j Medical gas(value:$ ) Page 2
_0
Primer 12.51
Contact name:
,rj no.:0a drain(commercial) 12.51
t �it,,, .1 i Sink/basin/lavatory 25.02
City/State/ZIP: 1-..1- 0 j A
7e) Solar units(potable water) 62.54
Phone:(5S3-6 I F,----2/ / Faax::( ) Tub/shower/shower pan 12.51
Email S �„y ,O -\i, Ict Y10/_.4c `6 l c )vIl Urinal 25.02
Water closet
25.02
.:f;," v �' , �> v ,xw :, ;CONT1241�TOR;_ � � "` '� �
Business name: --- Water heater 37.52
)C3 111 G�r 1 Fr LNC P P g/D T
Address: V a l5 r Br) v2�)t 1 71 c� Water i in 56.29
Other: 25.02
City/State/ZIP: 1` r
t "ii. cr r AO Subtotal
Phone:(50' ..., i „"?1/'� Fax:( ) Minimum permit fee: $72.50
CCB Lic.: illi Plumbing Lic.no.: Plan review (25%of permit fee)
w .
State surcharge(12%ofpermit fee)
Authorized Si
__.---
y TOTAL PERMIT FEE
Print name: 11 Date. _ •� This permit application expires if a permit is not obtained within 180 days
1
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 S stems:
Fee ea) To* Square,Footage: Permit Fee . , ,, # �: -...
Site Utilities ,° oto 2,000 $121.90
Footing drain-151 100' 50.03 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.Fees , ' tt
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
each additional$100.00 or fraction thereof,to
'- 'Tot and including$10,000.00.
pherSIn ectiins nor Feese k.,
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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr 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 to4. 4.
accurately report fixtures could result in increased sewer fees*. ' Plat e'e 'four plus b g I stall�> s. ` ,
Quantity by Fixture,Type ' Plan review is required for any of the following.
Fixture Type forReplace/ 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" or 3" A iso t "lig o Js r . ,.
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:
17363 SW AMELIA ST, BEAVERTON, OR, 97007 June 8, 2018 at 11 :10:15 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00162
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Febco model 850 irrigation backflow device ser#HE56301 located right side of
structure behind gate approved with test report.
Violation Summary:
Inspector Contractor