Permit (161) II L.
CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2019-00167
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2019
Parcel: 2S110AC04200
Jurisdiction: Tigard
Site address: 11074 SW ANNAND HILL CT
Project: Annand Heights, Lot 19 Subdivision: ANNAND HEIGHTS Lot: 19
Project Description: Backflow preventer for 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 04/24/2019 $31.27
Specifics: 1 12%State Surcharge- 04/24/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/24/2019 $41.23
Plumbing
Class of Work: ALT
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 +btain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1 :10 .2344. ,
/
Issued By: Permittee Signature: al
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 LSF ONLI
City of Tigard
Ti and Received
d
Date/By: '//
Lf//q 9L77_ Permit No,:!��)(Jete
t `t`13125 SW Hall Blvd.,Tigard,OR 97223 �• Plan ReviewC Phone: 503.718.2439 Fax: 503.594 Date/By: Other Permit No 7 tt'` _`}o
g?
Inspection Line: 503.639.4175 ,1 I GARD Date Ready/By: Turfs: ® See Page 2 for
Internet: www.tigard-or.go
010 Notified/Method: m Supplemental Information
TYPE OF W Ilik Y ® FEE* SCI D
IZ New construction li Ii� � 0 For special information use checklist
ti.7` '0 Description Qty. Ea. Total
❑Addition/alteration/replacement 1l •1 � New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF -' ON SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
El Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
Ifgi SPIE INFORMATTQN AND LOCATION Site utilities:
Job site address: 110 7 L( ,U n 1- d 14, I l (,.J Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: l c94 t-d 9 7 2 L 3 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
\A) ` N wo 4 p -40 P6-J Rain drain connector 18.76
0 6
S� 5(c) 1`1 UQk 1 ` Sanitary sewer(no.linear ft.:_) Page 2
I
CL
2(' U i n yF f� OAVI)
�/ Storm sewer(no.linear ft.:_) Page 2
C Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item: - _ _
Tax map/parcel no.: Backflow preventer + 31.27 _ ,a7
N a' Backwater valve 12.51
.... OESCRi ' �. 'VORIC .,, 4
x''..
1 I/ Clothes washer 25.02
r ' 25.02
uGC K.E��?�i pre JG?Y\ --)1r• Dishwasher
t--t i fl'S COIr C' S C r 1 n C-'E'r` Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERW]OW ER .' 4 0; Expansion tank 12.51
Name: P t - Fixture/sewer cap 25.02
I 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
,❑ APPLICANT 0 CONTACT PERSON :_ Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
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
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: 512.,'UE Z.
Water piping/DWV 56.29
Address: c,,,t l 3 1 I/o (1,..1 c)E`eL,- 14 {� -). I Other: 25.02
City/State/ZIP:( UA-,\'`U 0 ye _
�a A (, 3 Subtotal -3 I,):7Phone:( ) 360,2 s C 33 E3g1, Fax:( ) Minimum permit fee: $72.50 '7A,91
CCB Lie.: 7/3 I Plumbing Lie,no.: Plan review (25%of permit fee) -'
t aJ / State surcharge(12%of permit fee) 3-.70
Authorized signature: TOTAL PERMIT FEE Jr/•N1
Print name: Sc (ue f Date: / 21 /r 9 This permit application expires if a permit is not obtained within 180 days
t / / 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 .ti Fee Oa) . Total *more Footage: ,`. Permit Fee:
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
Valuation: Pertrit Fee: t.
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
ectior Fees Qo'• Fe� each additional$100.00 or fraction thereof,to
Other Inspections
h, . ) Total
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*. , n Review fo*' 'lumbif g lnf .. ati 4 .
Quantity by Fixture a Plan review is required for any of the following.
Fixture Type for Please check all that apply.
Work Performed: Capper Added Raeelde
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
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic El 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"
• ma i ` 1 ;*ci
Q 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 PetmitApp.doc 08/04/2011 2
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11074 SW ANNAND HILL CT, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2019-00167
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
1 " febco model 850, serial number E92479 located left front.
Violation Summary:
Inspector Contractor