Permit (79) CITY OF TIGARD PLUMBING PERMIT
"ri 2: '- COMMUNITY DEVELOPMENT Permit#: PLM2019-00352
T[G,A.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2019
Parcel: 1 S134BD11800
Jurisdiction: Tigard
Site address: 12079 SW SUMMERBROOK LN
Project: Summerbrook,Lot 1 Subdivision: SUMMERBROOK SUBDIVISION Lot: 1
Project Description: Backflow preventer for sales trailer.
Contractor: GRO OUTDOOR LIVING Owner: WILLOW CREEK LAND LLC
PO BOX 821569 PO BOX 1060
VANCOUVER,WA 98682 WOODBURN, OR 97071
PHONE: 360-727-5975 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/28/2019 $31.27
Specifics: 1 12%State Surcharge- 08/28/2019 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 08/28/2019 $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 1.800.332.2344.
Issued By: .
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Permittee Signature: ,'�,.[yc� ���
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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 RECEIVE II
City Of Tigard AU G 2 8 2019 Received I4 tot
DatelBy: �- PermitNo.:I ,n
III n 13125 SW Hall Blvd.,Tigard,OR 97223t'yr �i'LV ,
Pian Review
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Phone: 503.718.2439 Fax: 503.598.196tiTY OF TIGARD Date/B : Other
, PermitNo.:{ �1�
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'Ins ection Line: 503.639.4175 BUILDING DIVISIO Date Ready/By: rnr,a g5 See Page2 for
TIGARD Internet www.tigard-or.gov Notified/Method: Su lemental Information
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0 New construction Demolition For special information use checklist.
Description I Qty. j Ea. I Total
• Addition/alteration/repIacement U Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
r k �,,,g �'p Ii r" N' SFR(1)bath 312.70
rl�h Iu �t.;dsn�-r,�..�, .,�,.�ne r y k��
El1-and 2-familY SFR(2)bath 437.78
dwelling El Commercial/industrial
lip SFR(3)bath 500.32
Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
Master builder ���Other:Manufactured
r r it tier rk .. mit ,,p0,""in Fire sprinkler( sq.ft.) Page 2
t++lXIA '.' u,hu.�,1d° 9 � � j)(u'f i 4.t, " r a m:�t,,,` li'1 pleft Site utilities:
Job site address:12079 SW Summerbrook Lane Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard/OR/97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: l Project name:Summerbrook 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:Summerbrook , Lot no.:1 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
�r e' 4Tip ,�" +,s,ii+t i Backwater valve 12.51
Clothes washer 25.02
Irrigation and backflow to lot 1 for sales trailer landscaping
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
tq i l - i� fi '"eY A 1W
Expansion tank
12.51f4.1._ ,_ A - ', .,..,'40--z--„,. k® ., _,, ,,
Name:Weekley Homes LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:1905 NW 169"Place Suite 102
Garbage disposal 25.02
City/State/ZIP:Beaverton/OR/97006 Hose bib 25.02
Phone:(503)213-4415 Fax:( ) Ice maker 12.51
r is rp ,FkWr s `'il, fid@ riac ^ a�l a Interceptor/grease trap 25.02
Business name:David Weekley Homes Medical gas(value:$ ) Page 2
Contact name:Michele Schiedler
Primer 12.51
Roof drain(commercial) 12.51
Address:1905 NW 169"Place Suite 102
Sink/basin/lavatory 25.02
City/State/ZIP:Beaverton/OR/97006 Solar units(potable water) 62.54
Phone:L503) 1 .44L4 _ .: -..�- -Eva.: -..;._Tut wd
----•---- _ � --_ -�__ _ ___-_ __--. pess... .__..___----- _ _, 1 .33 __ _ _ ... ----
E-mail: Urinal 25.02
25.02
« ,, ± _ Water heater 37.52
Business name:GRO OUTDOOR LIVING WaterPip t m
g/DWV 56.29
Address:5800 NE 88"Street Suite 101 Other: 25.02
City/State/ZIP:Vancouver/WA Subtotal
Phone:(360)727-5974 Fax:(NO) 862. 881 Minimum permit fee: $72.50
CCB Lic.:193268 Plan review (25%of permit fee)
Phtmbing Lic.no.: �\
State surcharge(12%of permit fee)
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Authorized signature: 4,
"-lr, %Tt�rt�1 TOTAL PERMIT FEE
Print name: 1..V 46 D 1,4 L? Date: 8/�/19 This permit application expires if a permit isnot obtained within 180 days
D after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule:
pt? va, hEiu y
soi
Footing drain-1'100' 50.03
Footing drain-each additional 100' 37.52
Sewer-1st 100' 62.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54
Storm&Rain Drain-each additional 100' 37.52
NTO .00
Inspection of existing plumbing or for
which no fee is specifically indicated 90.00/hr
(minimum charge-1/2 hour)
Inspections outside of normal business 90.00/hr
hours(minimum charge-2 hours)
Reinspection Fees 90.00/hr
Additional plan review for revisions 90.00/hr
(minimum charge-1/2 hour)
Subtotal:
Residential Fire Suppression Systems:
$gUar.�F bti c:��, Prot Fee;
0 to 2,000 $121.90
2,001 to 3,600 $169.69
11 3,601 to 7,200 $233.20
7,201 and greater $327.54
Medical Gas Systems:
$1.00 to$5,000.00 Minimum fee$72.50
$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
and including$10,000.00.
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
each additional$100.00 or fraction thereof,to
and including$25,000.00.
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
each additional$100.00 or fraction thereof,to
and including$50,000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or fraction thereof.
Floor Drain/sink -2"
-3"
Commercial Fixture Work: Car Wash Drain
please indicate work performed by fixture. Failure to Disposal
Com rciaood related
Commeercial-food related
accurately report fixtures could result in increased sewer fees*. -Industrial-food related
Quatiti by Flzture`t5'Pe Ice Mach./Refrig.Drains
iztur " e for Oil Separator(Gas Station)
Work 1Peioi med:` APPed Added: ,`Relocate
- Rec.Vehicle Dump Station
Baptistry/Font Shower -Gang
Bath -Tub/Shower -Stall
-Jacuzzi/Whirlpool Sink/Lav -Non-food related
Car Wash -Each Stall -Bradley
-Drive Thru -Commercial-food related
Cuspidor/Water Aspirator -Service
Dishwasher -Commercial Swimming Pool Filter
-Domestic Washer-Clothes
Drinking Fountain Water Extractor
Eye Wash I Water Closet-Toilet
I:\Building\Permits\PLMF-PermitApp.doc 2
Urinal
Other Fixtures:
Plan review is required for any of the following.
Please check all that apply.
El A• ny new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
engineer.
0 N• ew exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
M• edical gas and vacuum systems for health care facilities.
0 Any multipurpose fire sprinkler system.
El Any complex structure as defined in OAR918-780-0040.
Submit 2 sets of plans with any of the above.
tit •
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0 Isometric or riser diagram is required for new buildings
that meet the qualifications above.
Comments regarding fixture work:
*Note: If the fixture work under this permit results in an
increase of sewer EDUs,a sewer permit will be issued and
fees assessed for the sewer increase must be paid before the
plumbing permit can be issued.
I:\Building\Permits\PLMF-PermitApp.doc 12/30/05