Permit (48) CITY OF TIGARD PLUMBING PERMIT
,'' COMMUNITY DEVELOPMENT Permit#: PLM2019-00310
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2019
Parcel: 1 S 134ACO2660
Jurisdiction: Tigard
Site address: 11338 SW COTTONWOOD LN
Project: LAMONT Subdivision: ENGLEWOOD NO.3 Lot: 226
Project Description: Backflow preventer for irrigation.
Contractor: LAND-PRO LLC Owner: LAMONT, CHERYL A
1625 SE OAK ST APT 34 11338 SW COTTONWOOD LN
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 971-327-1363 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/05/2019 $31.27
Specifics: 1 12%State Surcharge- 08/05/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/05/2019 $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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: l Permittee Signature:
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 FSE ONE)
City of Tigard Received ��^� ��q
e "`a Date/By: i 7
41 �� C Permit No.: ,C)/j1/14-)1q--W3(
l�' YX� �l�C.{/ i
13125 SW Hall Blvd.,Tigard,OR 97223 t
m� Y,.,. .- Plan Review
IN = Phone: 503.718.2439 Fax: 503.598.1,91'r., i Date/By: Other Permit No.:
T 1 G A R 1 Inspection Line: 503 639 4175 14 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov (i l
� � � Notified/Method: � 4�jt. Supplemental Information
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F1 ew construction ❑Dertio4ftori For s ecial in ormation use checklist
Description Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
. CATTEGOR' OF CONSTRUCTION SFR(1)bath 312.70
and 2-famil dwellin SFR(2)bath 437.78
y g ❑Commercial/industrial
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE`INFORMATIi; IN.,AI+iD .ATIbN Site utilities:
`� Catch basin or area drain 18.76
Job site address:
1/ 33f Cy.)4 4,e: u%c",,1 d ,),..1
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 0)y,}E 2.
ki+. t 0 ` 7"i 1� g
J Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: ( "Project name:
i/nt:W ` 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer ✓1 31.27
Backwater valve 12.51
Clothes washer
13t,Lt �1G'�i.✓` / ,, 25.02
i / +Y�lA/��J� tC� t t 15"�j1 t( /,,/� Dishwasher 25.02
(oil q(A. n G°{N Drinking fountain 25.02
Ejectors/sump 25.02
, ,.,, t y .47'1i It .-- '`' Rq Expansion tank 12.51
Name: , Fixture/sewer cap 25.02
Address:
a„�/- J 1rLIJ� Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
4;0 !LII✓AI' '...t',1%'4':':41'i -: Interceptor/grease trap 25.02
Business name: it5 ` ,„ 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: Urinal 25.02
�
> . 'In Water closet 25.02
Tom.. CT(IR` '�-. .
Water heater 37.52
Business name: /t..."--
�:� A
Aro G ( Water piping/DWV 56.29
Address: k;2.- -- '/ f J j. .:' i Other: 25.02
City/State/ZIP: /.' iii //446, i 6) ,/,,k/.,/ Subtotal 7/.4)--)
Phone:(.7? ) i / Fax:( ) Minimum permit fee: $72.50 -7,„ _r
Yl Plan review (25%of permit fee)
CCB Lic.: l L,e, ; �� J.jylumbing Lc.no..
1 State surcharge(12%of permit fee) 74.)
Authorized signature: V TOTAL PERMIT FEE 2..,,
Print name: /� Q This permit application expires if a permit is not obtained within 180 days
(Ail z-kA.0 /I 7/t.-7e� Date: (;�J' '"C>5`" 2ci't y 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 ()Or' Fee(ea) Total Square Footage: Permit Fee:
Footing dram-151 100' 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: PPerndt Fee:
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
: Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees Q Y; Fee ) 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*. ;` anl., view for Plumb r. 1, j s4=;_
Quantity b.T Fixture Type Plan review is required for any of the following.
Fixture Type for ReFlacel 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercialirator
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"
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
Tel: 503.718.2439
Location: Inspection Date:
11338 SW COTTONWOOD LN, TIGARD, August 19, 2019 at
OR, 97223 11 :20:33 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00310
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Wilkins irrigation backflow device model 350 ser#A841636 located right front corner of
house approved with test report.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11338 SW COTTONWOOD LN, TIGARD, August 19, 2019 at
OR, 97223 11 :20:33 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00310
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Wilkins irrigation backflow device model 350 ser#A841636 located right front corner of
house approved with test report.
Violation Summary:
Inspector Contractor