Permit (96) CITY OF TIGARD PLUMBING PERMIT
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'< COMMUNITY DEVELOPMENT Permit#: PLM2018-00234
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/15/2018
Parcel: 2S 106 D B07400
Jurisdiction: Tigard
Site address: 17476 SW CLEMENTINE ST
Project: VANDERHOEST Subdivision: RIVER TERRACE NORTHWEST Lot: 74
Project Description: Backflow preventer for irrigation.
Contractor: LANDSERVICES INC Owner: ROBERT VANDERHOEST
PO BOX 1777 17476 SW CLEMENTINE ST
NORTH PLAINS, OR 97133 BEAVERTON, OR 97007
PHONE: 503-644-8575 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/15/2018 $31.27
Specifics: 1 12%State Surcharge- 05/15/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/15/2018 $41.23
Class of Work: OTR Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: - mittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLI
City of Tigardr'e8,8***9
Received J
111 11,11
13125 SW Hall Blvd.,Tigard,OR 1.11 Date/By: 5//'�`//1.' A- Permit No.:
C Phone: 503.718.2439 Fax: 503.59 ,1 0 '. i• , Plan Review (( -
Inspection Line: 503.639.4175 �� to/By: Other Permit No.:plink lip_! 'I
TIGAKD M V'�CA; � eReady/By: ,�
Internet: www.tigard-or.gov
Jur Supplemental See Page 2 Informationnr
� �•�� �, Notified/Method:
� '��./ �� (�/
`fiYPE`OF 'WORIt '' 0;
�� " � % FEE* SCHEDULE'
ANew construction 1 ❑Den For special information use checklist
D Addition/alteration/replacement Description Qty. I Ea. I Total
❑Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY' OF NCONS IRLJCTJOI+1 , .., s z SFR 1
'� � � A'x :*>:.;�. Obath 312.70
)21_1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other
Fire sprinkler( sq.ft.) Page 2
4O$ SITE INFORMATION Q LOCATION '
ANSite utilities:
Job site address: j "� � /i � Pr 5� Catch basin or area drain I 18.76
City/State/ZIP: 16,, yLu,...fct c Slit' & ci-.)C 0 1 Drywell,leach line,or trench drain 18.76
€ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 6
,�k r�(j,,A) Manufactured home utilities 50.03
Cross street/directions to job site: 5-,: .. v.m t,\ tkii,j LI Manholes
{��ll^'t-��r�t 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
Lot no.: Fixture or item:
Tax map parcel no.:
Backflow preventer 31.27 '3i ) 7
' = DESCRII '1oN o` '' ' } /
w� �, �� �, 4 � Backwater valve 12.51
1 Clothes washer 25.02
N54-,54-,, \II N l hr iJe.f 1 0 Cl iJjpk Cli,ci: Dishwasher
25.02
g Drinking fountain 25.02
R ,_, Ejectors/sump 25.02
14001;00
Ein Owwl iEii 4 01 4 0 0
". w ' Ie ' . r Expansion tank 12.51
Name: 1,26."..-1-- V e)IV/j ea /40
l C-es Fixture/sewer cap 25.02
Address: ) 7 7 V �4 L Floor drain/floor sink/hub 25.02
,1,,,,-I : <j-i-
City/State/ZIP: � CIA 7?o,
7 6 0-2
Garbage disposal 25.02
7
� �J. t i-• Hose bib
Phone:( ) 25.02
Fax ( ) Ice maker
;; � 12.51
�
'.,LTC g
`may � ` � � ��� `1' ' Interceptor/grease trap 25.02
Business name: L4 N41, {i t cz 5, 1 N L Medical gas(value:$ ) Page 2
Contact name: S U lz Primer 12.51
-� i I/i 4.,; S"
Address: ' 7'' Roof drain(commercial) 12.51
' I 1 77 Sink/basin/lavatory 25.02
h
City/State/ZIP: i oi,.-f 1,, //o j%> ( 12. 97/33 Solar units(potable water) 62.54
Phone:( 3) ( Lt q"1, '7`-- Fax::( ) Tub/shower/shower pan 12.51
E-mail: 1.° c1s��v 'Co St eV-;'5-c of . 62�1 Urinal 25.02
Water closet
' J O TORS; .4 4 ' t " P 25.02
Business name: Water heater 37.52
� � � S f nvc, Waterpiping/DWV 56.29
Address: f f r /-7 7
Other:Other: 25.02
City/State/ZIP: G,%^ +-h 1Q�a, 0''5' U -,I /7 / 3
1 � i , Subtotal
Phone:(';3) C�{L"i 11'7 5' Fax:( ) Minimum permit fee: $72.50
CCB Lic.: th',�sk 51 Ci\ l y/9c),/f,i, Plumbing Lic.no.: Plan review (25%of permit fee)
Authorized signature: _. J State surcharge(12%of permit fee)
j ` TOTAL PERMIT FEE
Print name: - 4'-e 02 0 i' 1 r A ,i, . I Date: 5-- /�/3 I 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\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:
,
,QtY,' ,FFe ea) Total S;quare;Footage: Pemrt"Feef, ,,, ..x =. ',
Site LTt�lt><e� � r �, � $121.90
Footing drain-1' 100' 50.03 0 to 2,000
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 3,601 to 7,200 $23320
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' 37.52Valuation: ermit 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 fore of a each additional$100.00 or fraction thereof,to
Other Inspections or:Fees Qt3' T, 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.
$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 to
.rim
accurately report fixtures could result in increased sewer fees*. lau, evlew'for ti I g ii atipi s }
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for 1 , Reinke/ Please check all that apply.
Work Performed:. Capped Mlded.' . Ralocate 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 Thin 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" z 4. .k ' ,, 4'
-3" ,,, x s n1 I it e lii I i
. s cantor ..
4'>
ti 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/Sery/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:
17476 SW CLEMENTINE ST, BEAVERTON, May 24, 2018 at 9:45:04 AM
OR, 97007
Record Type: Record ID:
Residential - Plumbing PLM2018-00234
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Febco irrigation backflow device model 850 ser#HE65995 located right side of front
porch by fence approved with test report
Violation Summary:
Inspector Contractor