Permit (121) CITY OF TIGARD PLUMBING PERMIT
� COMMUNITY DEVELOPMENT
Permit#: PLM2018-00522
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/08/2018
Tfttz• Parcel: 2S111AA01400
Jurisdiction: Tigard
Site address: 8824 SW INEZ ST
Project: Butterfield Park,Lot 3 Subdivision: Lot:
Project Description: Backflow preventer for irrigation.
Contractor: AUSTIN BROWN LANDSCAPE Owner: DAVID DEHARPPORT
PO BOX 14441 PO BOX 1577
PORTLAND, OR 97293 BEAVERTON, OR 97075
PHONE: 503-887-7795 PHONE: 503-720-7445
FAX;
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/08/2018 $31.27
Specifics: 1 12%State Surcharge- 11/08/2018 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 11/08/2018 $41.23
Type of Use: SF Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set ••• a •IR 952-001-0010 through OAR 952-001-0090. You ma obtain a copy of the rules
or direct questions to OUNC by calling 503.2 •.1987 or 1.800.332.234,
Issued By: -- •••• Si.nature:
Cal��39.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completi•n of project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures -,,, FOR OFFICE 1 SE ONL1
City of Tigard 1 e '4 e' ax k" Received y _
Date/By: /1 75.A O Permit No.: 1P46/90.
<M I�r--6135:4,
13125 SW Hall Blvd.,Tigard,OR 97223 I I (J
8 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.19ti h Date/By: Other Permit No.:/G7- f ,
Inspection Line: 503.639.4175 ,, Date Read/B Juris: ® See Page TIL. R D Internet: www.tigard-or.gov . ,i '. 1.1`+.:z„1.!--,1_,_, Notified/Method: )$ Supplemental Information
TYPE OF 4) wING MOON FEE* SCHEDULE
72raew construction 0 Demolition For s ecial in ormation use checklist
Description �� Qty. I Ea. Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF,CONSTRUCTION SFR(1)bath 312.70
and 2-family dwelling 0 Commercial/industrial
SFR(2)bath 437.78
❑Accessorybuilding
SFR(3)bath 500.32
g 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: q4( Y'W I N Catch basin or area drain 18.76
1 Drywell,leach line,or trench drain 18.76
City/State/ZIP: H
( i,vi U,.ti om 2 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: II Project name: B7 {7T �b'�L 0 Manufactured home utilities 50.03
Cross street/directions to job site: ��// t Manholes 18.76
)16-''7-- 1 q-c' Rain drain connector 18.76
`J I `5 Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
� ? �� 3
Water service(no.linear ft.:_) Page 2
Subdivision: '"l , 1 Lot no.: Fixtuureeoror item:
Tax map/parcel no.: Backflow preventer 1 31.27 .
DESCR NOF wowBackwater valve 12.51
:
Clothes washer 25.02
I i )S--r Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
felegtOPERTY OWNER I 0 NE,,ANT Expansion tank 12.51
Name: [ �'v` � �. Fixture/sewer cap 25.02
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
'!APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: AckitS--(1 i) i,a � WAILtC5Wr ry Medical gas(value:$ ) Page 2
PrContact name: v I ,11� ,6 tj Roof 12.51
d
P "L 1 /1` 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
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: 4AS,ieloj e e, w1,J C4OL',f i ki1/i Water piping/DWV 56.29
Address: O ' s "'1\ Other: 25.02 MI
City/State/ZIP: 0 / V Subtotal
Phone:(� ) G*S 74/11 Fax:( ) Minimum permit fee: $72.50 2/_513
CCB Lic.: ,VIP-9-'(;' firjric.no.: _ Plan review (25%of permit fee)
/'- _�� A State surcharge(12%of permit fee) •
Authorized signature: e TOTAL PERMIT FEE MEI
Print name: /t�S� ' / , "
8, e: /f� This permit application expires if a permit is not obtained within 180 days
` _ l V 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:
Site Utilities OtY, Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1"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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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
Other Inspections or Fees Qty.
Fee(ea)
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*. Plan Review for Plumbing Installations,
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ 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
Stall 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Eachas defined in OAR918-780-0040.
-DriveTani
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic ❑ 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 isometric or Riser Diagram
0 Isometric or riser diagram is required for-new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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:
8824 SW INEZ ST, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2018-00522
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 1 " Wilkins DC model 350, serial # A772666, for irrigation,located at left front side of
house- approved with test.
Violation Summary:
Inspector Contractor