Permit (25) aF
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00254
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 05/30/2018
Tt18.L? 9
Parcel: 2S 108DB07700
Jurisdiction: Tigard
Site address: 15243 SW SEINE DR
Project: EVERIDGE Subdivision: POLYGON AT BULL MOUNTAIN Lot: 75
Project Description: Backflow preventer for irrigation.
Contractor: CASCADE LANDSCAPE AND CONSTRUCTION INC Owner: EVERIDGE, KEVIN THOMAS&DENAL E
PO BOX 552 15243 SW SEINE DR
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503-625-4112 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/30/2018 $31.27
Specifics: 1 12%State Surcharge- 05/30/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/30/2018 $41.23
Class of Work: OTR Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800 332 23.4.
Issued By: AilOrPermittee Signature:
_Ada....NC_.r - (7.1717/1_,6
I.'
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLI
City of Tigard CRE EIS''a _'Ya f
= /B PermitNo.: /01."19.0
" / y..tio) /
q 13125 SW Hall Blvd.,Tigard,OR 97223 �t� -
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
TI G A R D Inspection Line: 503.639.4175
MAY Z�} Date Read/B
Internet: www.tigard-or.gov
Ready/By: Jura: See Page 2 for
p �, y Notified/Method: �_J„ey Supplemental Information
R ,� TYPE''OF WORK I O TIGA ' FELE*$CIIEDULE
❑New construction _ t a �} For. 4'y' `?
0 D "C111lliNG DWISJON s ecialin ormation use checklist
Description
❑Addition/alteration/replacement 0 Other: Qty • 1 Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
4 ...-x CATEGO1tY4l
'F CO1NST earioNI'" .4. 4 k; _. SFR(1)bath 312.70
❑ 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
I r.JOB SITE=IN ,Fp RMATIOTq 4,,„740-41, Allo Site utilities:
Job site address: %52t3,5, )jam,. ,/� dY Catch basin or area drain 18.76
City/State/ZIP: ---7)11, 1-' r�+�,/ e ,� L, Drywell,leach line,or trench drain 18.76
1�- Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 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
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer / 31.27 31 7
i V ' lam' Backwater valve
_ .•: )IIES'CRIE10 Off: 12.51
Clothes washer 25.02
"r t Lr -6_4-- rYr,,.....,.? ?..1,v Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
" o
(PERR Owr I R a'. N ti """: ' Y :,k Expansion tank 12.51
Name: ��/'± i��J/ t AW,?'� Fixture/sewer cap 25.02
Floor Address: �� f/'� (--fri✓,� , V. Cc-114(4W
Garbage disposal
25.02
C' (i.../(7Garbage disposal 25.02
City/State/ZIP: Q� 2
( !_( Hose bib 25.02
Phone:( 1j � 17--k 674("74,, Fax ( ) Ice maker 12.51
4 ...-L C APFL11Cfl f s '''o) Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
1 Contact name: c Primer 12.51
�J 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
E-mail: Urinal 25.02
' IP .4 : k. Water closet 25.02
r.k: x CONTR4,CT,94 i. 14. :. 1 ' ,
Water heater
Business name: K' 4s•+,l04Sr�� W56.29
�
',
Water piping/DV 56.29
Address:
t✓ se„ S--3--a Other: 25.02
City/State/ZIP: f _�� j/ C', �`�/�� Subtotal 3J 42--7
Phone:(5j ) J6,,,2,5-_, iiij� om-D Fax:( ) Minimum permit fee: $72.50 -22,Sv
CCB Lic.: /'0`C�)c -74 Plumbing Lic.no.: Plan review (25%of permit fee) -
State surcharge(12%of permit fee) 7o
Authorized signature: 1 ;/f,,.., /�j
t w G TOTAL PERMIT FEE 87
Print name: /` Date: rmit 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.d°c 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:
Qt Fee(ea) total..: Shuart nota a Nrinit Fee'
Footing drain 15`100' 50.03 0 to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 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:
37.52
Water Service-each additional 100' TPY'IY11t FQQ 3t
aU�tl�lri
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
p :,' I� eita) Total
each additional$100.00 or fraction thereof,to
Qtl1Cr I1S ctlo � +�'�'es � '� ; , 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$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. #
}dor l cn$ ktallatioaS. ..
Quantity by Fixture Type . Plan review is required for any of the following.
Fixture Type for - ;Replace/ Please check all that apply.
Capped AddedRelocate..,.
Work Performed: ❑ 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" a. v � x
'I x etl• S T= 1 H
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:
15243 SW SEINE DR, TIGARD, OR, 97224 July 11 , 2018 at 11 :16:32 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00254
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Febco backflow device model 850 ser#67877 located left of front porch approved with
test report.
Violation Summary:
Inspector Contractor