Permit (168) CITY OF TIGARD PLUMBING PERMIT
`' COMMUNITY DEVELOPMENT Permit#: PLM2019-00074
Date Issued: 02/26/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110AC04300
Jurisdiction: Tigard
Site address: 11058 SW ANNAND HILL CT
Project: Annand Heights,Lot 20 Subdivision: ANNAND HEIGHTS Lot: 20
Project Description: Backflow preventer for landscape irrigation.
Contractor: S RIVER LANDSCAPE AND CONSTRUCTION Owner: ANNAND HILL LLC
513 E 16TH ST,APT B-21 BY RICHARDS, M DALE
VANCOUVER,WA 98663 12655 SW NORTH DAKOTA ST
TIGARD, OR 97223
PHONE: 503-801-4709 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/26/2019 $31.27
Specifics: 1 12%State Surcharge- 02/26/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 02/26/2019 $41.23
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 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 =et.. 44.
Issued By: Permittee Signature:
"gam
Call 503.639.4175 by 7:00 a.m.for the next available inspection da .
This permit card shall be kept in a conspicuous place on the job site until compl ion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application.. r •.. . , ,-.
Building Fixtures FOR OFFICE. USE OyI.v
City of Tigard FEB ", a¢ Received �f ��/������ �J���Y !i
13125 SW Hall Blvd.,Tigard,OR 972232 Date/By: ,.0 /�� 7 /
I Plan Review - 1 } 2
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: JS�Jyg9(r
T I G A R U Inspection Line: 503.639.4175 Date Ready/By: Juris: See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
n New construction 0 Demolition For special information use checklist
/ Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSCRVCTION SFR(1)bath 312.70
q 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
.f# ,_- 1OB SITE INFOR LION AND LOCAtI{ON, Site utilities:
Job site address: 1 1 tab _ A)01.11 el Fl i 1 i C
Catch basin or area drain 18.76
/// Drywell,leach line,or trench drain 18.76
City/State/ZIP: C
` Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I i Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
r 07204 s-.` -, y/
.�� Rain drain connector 18.76
IN ''',,-.i-,0
' c Sanitary sewer(no.linear ft.: ) Page 2
�` � k/ l rl Storm sewer(no.linear ft.:_) Page 2
A'c ` `�I 1 IWater service(no.linear ft.: Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer t 31.27 31.2...7
DESCRIPTION OF WORK _Backwater valve 12.51
Clohes washer 25.02
. ^-V- . `1 i V / CV O'rtik' Dishwasher 25.02
�13,,(1iDrinking fountain 25.02
Ejectors/sump 25.02
12.51
❑t PROPERTY OWNER x 'y :,. t Expansion tank
.Name: 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
0 APPLICANT 0 CONTACT PEON Interceptor/grease trap 25.02
Business name: -Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
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: �D'C/ .5 a SCG r ¢ /dam._t, (4' ' Urinal 25.02
�+ `"^' ✓� � 25.02
CONTRACTO`
,,,-,,-,,:sWater heater 37.52
Business named' - / �b Li a ill!S 't a U L! ater piping/DWV 56.29
Address: C tpf i ----,'- I Other: 25.02
City/State/Z1P aUtk 12 uJ A si(_ 3 Subtotal 3(,
Phone:A5b- - _�l��9 Fax:( )
Minimum permit fee: $72.50 "7,,,S)
l Plan review (25%of permit fee) `-
CCB Lic.: { f Plumbing Lic.no.: '7 State surcharge(12%of permit fee) '.
Authorized sign9.1 {y °Z/ TOTAL PERMIT FEE /,
���/777 l�� This permit application expires if a permit is not obtained within 180 days
Print name �j y / f g//`p� ` Date /tel 2�f y after it has been accepted as complete.
$$$/// ` 111 v l *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 Qty. 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 ValuationPermit Peet
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
+ether Inspections Fees ` each additional$100.00 or fraction thereof,to
ea) otat
z p _ �-�.. «•' K• 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 Fixtuire`Typ Plan review is required for any of the following.
Fixture Type for : :ItePlatk Please check all that apply.
Work Performed: upped- Added Relocate
Baptistry/Font
0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure
Drive Tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
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"
4>,
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/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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
Julie Drinkwater
From: Nataly Vasquez <nataly@sriverlandscape.com>
Sent: Monday, February 25, 2019 3:06 PM
To: Julie Drinkwater;tigarbuildingpermits@tigard-or.gov
Subject: Re: LCB number
Hello Julie,
We spoke earlier today around noon in regarding my father Sergio Rivera. My parents came in this
morning to apply for the permit license in backflow. I am following up with my Landscape Contractor
license number: 9713. We are hoping to have this established today if possible. Please let me know
if you need additional information.
Thank you,
Wady ��/% uey/owner
O i
S River Landscape and Construction, LLC
nataly@sriverlandscape.com
Contact: 503-801-4709
Please note that the information contained in this message along with any attachments are intended for the
exclusive use of the addressee(s) and may contain confidential or privileged information. If you are not the
intended recipient,please do not forward, copy, or print the message or its attachments; notify me at the above
address; and delete this message and any attachments. Thank you.
On Mon, Feb 25, 2019 at 3:01 PM Nataly Vasquez <nataly@sriverlandscape.com>wrote:
,Hello Julie,
1
We'spoke earlier today around noon in regard to my father Sergio Rivera. He is applying for his
1 ,permit license in backflow. My Landscape Contractor license number: 9713. Please let me know if
you need additional information from me.
Thank you,
PAC/4 (_�4ity/Owner,
S River Landscape and Construction, LLC
nataly(asriverlandscape.com
Contact: 503-801-4709
{
Please note that the information contained in this message along with any attachments are intended for the
exclusive use of the addressee(s) and may contain confidential or privileged information. If you are not the
intended recipient,please do not forward, copy, or print the message or its attachments; notify me at the above
address; and delete this message and any attachments. Thank you.
I,
2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11058 SW ANNAND HILL CT, TIGARD, April 5, 2019 at 11 :12:22 AM
OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2019-00074
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Febco irrigation backflow device model 850 ser#96675 located by water meter
approved with test report.
Violation Summary:
Inspector Contractor