Permit (82) CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit#: PLM2018-00377
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/06/2018
T"I c;; h.C� 9 Parcel: 2S 111 AA01400
Jurisdiction: Tigard
Site address: 8867 SW INEZ ST
Project: Butterfield Park,Lot 10 Subdivision: Lot:
Project Description: Backflow preventer for landscape irrigation.
Contractor: AUSTIN BROWN LANDSCAPE Owner: FOUR D CONSTRUCTION
PO BOX 14441 P.O. BOX 1577
PORTLAND, OR 97293 BEAVERTON, OR 97075
PHONE: 503-720-7445
503-887-7795
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/06/2018 $31.27
Specifics: 1 12%State Surcharge- 08/06/2018 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 08/06/2018 $41.23
Type of Use: SF Plumbing
Class of Work: OTR
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 rul- adopt by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m. /obtain : .py of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
xe �'/%Permittee Signature: AllA_�'�
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 completio, of th , oject.
Approved plans are required on the job site at the time of each inspec on.
Plumbing Permit Application
Building Fixtures _ FOR OFFICE USE ONLY
City of Tigard AI I r ((; g Received ,( 2/' 8-,...6 ,..??-2
Y
ll l V G 2 V#iJ PlanRe Date/By: /(C���Y//� Permit No. V�
13125 SW Hall Blvd.,Tigard,OR 972 3 ""
Plan Review Other Permi
= Phone: 503.718.2439 Fax: 503.598(196(1 Date/By: A57�/8-�
Inspection Line: 503.639.4175 r3L ; • ��
T 1 G A R D { p y y. Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
z. TYPE O1' WORK 4 .
: �.�.. , � � n� ,� �� FEE* SCHEDULE
+ lew construction 0 Demolition For special information use checklist
Description Qty. I Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
'
CATEGORY OF CONSTRUCN SFR(I)bath 312.70
1-and 2-famil y dwellin SFR(2)bath 437.78
g ❑Commercial/industrial
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB;SITE"INFORMATION AND L)CTIO" i x Site utilities:
Job site address: K--6. ' S t - Catch basin or area drain 18.76
City/State/ZIP: "1--ri �� o
Drywell,leach line,or trench drain 18.76
C Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: (a -r-ct---7 tar) 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
Stone sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Cl7u"f.- e-y.f- 1.-:"Z.-4) I Lot no.: 101 Fixture or item:
Tax map/parcel no Backflow preventer 31.27
" t '" ,, * Backwater valve 12.51
.f ,• t SCRIPTION OF WO ,
• v AClothes washer 25.02
(7 ( Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
vim,
V z ROTS RTY 04:4 as l R r 0 4 1 Expansion tank 12.51
Name: 1- A L 0 � Fixture/sewer cap 25.02
w ` V . I, 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
APP% r, CO ACT ma'Old :" Interceptor/grease trap 25.02
Business name: �V\�lt)v ,p r6.W a Ak ► s Medical gas(value:$ ) Page 2
1I7g( VY`"'� Roofd 12.51
Contact name: ��S'1-/
drain(commercial) 12.51
Address: pG / - 47, Sink/basin/lavatory 25.02
City/State/ZIP: 6,,i-/Q,,CJ . ' 7273 Solar units(potable water) 62.54
Phone:( .g s-y? ?-'�s�. T Fax: :( 6 ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
r - Water closet 25.02
: •v. ONTR4 4,4-.,;n7 ' t
. k , t •. Water heater 37.52
Business name: ms-1 /la 1� z.,4,(,/1 E ,�j
�+ u Nt3� Water piping/DWV 56.29
Address: fo 400 iv(l Other: 25.02
City/State/ZIP: f o ri t l4 ,•''2-i 3 Subtotal
Phone:(71$ ) Fax:( ) Minimum permit fee: $72.50
q� i� Plan review (25%of permit fee)
CCB Lic.: a i i Plu�� g Lic. • •
aCl _
/ State surcharge(12%of permit fee)
Authorized signature: � ..•/ �^
�� 7 TOTAL PERMIT FEE 'Iii,(J
Print name: ii.. Ar � Date: yo-CO(1 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
I, *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:
,1Site�TL`ts Fe1��a
_ ) Squire FobOe
Permit F ::
Footing drain-1s 100'
50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
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 "`=rt. '
3 Val�atia#'., 'ermit'ee.
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
fy: iea) oi >I
each additional$100.00 or fraction thereof,to
Other InreChopa�or" ,' 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
(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*. an Review 1'olui' 0 o mg InS "
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/"= Please check all that apply.
Work Performed: Cat d #tided ~Relocate
❑ 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
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
CW
C -Commercial
al 0 Any multipurpose fire sprinkler system.
Dishwasher:
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3>, .. iso .= C o:. s 1 ®f ..o o rte:;: ,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
Ice Mach./Refrig.Drains Comments regarding fixture work:
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
Water Closet-Toilet plumbing permit can be issued.
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:
8867 SW INEZ ST, TIGARD, OR, 97224 August 10, 2018 at
9:44:59 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00377
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
1 " Wilkins model 350, serial # A230593 located right side.
Violation Summary:
Inspector Contractor