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Permit n CITY OF TIGARD PLUMBING PERMIT g COMMUNITY DEVELOPMENT Permit #: PLM2013 -00180 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/10/2013 Parcel: 2S 104BA00300 Jurisdiction: Tigard Site address: 12010 SW WESTBURY TER Project: DeLucia Subdivision: COTSWALD MEADOWS NO.3 Lot: 84 Project Description: Installation of residential backflow preventer. Contractor: PREFERRED LANDSCAPE SERVICES INC Owner: DELUCIA, LINDA R 380 NW 336TH AVE 12010 SW WESTBURY TER HILLSBORO, OR 97124 TIGARD, OR 97223 P PHONE: 503 - 267 -3951 HONE: 503 - 764 -2321 FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 06/10/2013 $31.27 Specifics: 1 12% State Surcharge - 06/10/2013 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment - 06/10/2013 $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 issuan - :. is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules ad• �ted by the Oregon Utili.• Notification Cent- . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. Y.0 may ob .1a copy of the rules or : irect questions to OUNC • • in• 503.232.1987 or 1.800.332.2344. Is ed By: /1 � � _ Permittee Signature Call 503.639.4175 by 7:00 a.m. for the next available inspection d =. 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 R eceived D City of Tigard Permi No.: III a 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: �0 3 �1�jZo 5 /SO Pl C Phone: 503.718.2439 Fax: 503.598.1960 an Review Dan Other Permit No.: T I G A K D Inspection Line: 5013.639.4175 Date Ready/By: Juris: 62 See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE New construction ❑ Demolition For special information use checklisL Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 V I 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 0 (, N , � Catch basin or area drain 18.76 ty 1 1' O� ` � Sw �� f Drywell, leach line, or trench drain 18.76 le City/State/ZIP: P } k„ ^ dl O Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: 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: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer ( 31.27 DESCRIPTION OF WORK Backwater valve 12.51 1'� Clothes washer 25.02 Lc K IJw Fetter' ' Dishwasher I 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 14 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: L � D I �L ∎� Fixture /sewer cap 25.02 Address: 01) O S f �C Floor drain/floor sink/hub 25.02 P S - bury 'afr Garbage disposal 25.02 City /State /ZIP: pt },u/`(/t / n e cr7ZZ3 Hose bib 25.02 ' Phone: (S03 ) 267 3551 Fax: ( ) Ice maker 12.51 , ❑ APPLICANT Ilk CONTACT PERSON Interceptor /grease trap 25.02 Pee ea( /..e.tv.,04sccet ` Medical gas (value: $ ) Page 2 ( Business name: �� 1 es Contact name: S-+&.& (o � Primer 12.51 Roof drain (commercial) 12.51 Address: 3 ,O ,t, ki 3 R g ')+` ✓, Sink/basin/lavatory 25.02 City /State /ZIP: '-)- 1) s l�r. t O`Z_ 9-71/`-1 Solar units (potable water) 62.54 Phone: ($103 ) -'b t _ �3 Z 1 Fax:: ( ) Tub /shower /shower pan 12.51 E-mail: ¢ r1 Et ci t reak le,, c ,, p e Sef\ -%‘ CPs, c, O w. Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: PreCrerrDa( 4 nd , $ Gap Q S2!'t - c eS Water piping/DWV 56.29 Address: cr. r ( _ Other: 25.02 City /State /ZIP: Subtotal 7A_57) 57) Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 �' �B Lic.: 1-C 8I 3 ). I I l Plumbing Lic. no.: Plan review (25% of permit fee) _.-- State surcharge (12% of permit fee) . 70 Authorized signature: . 7120 -- . / TOTAL PERMIT FEE 8 I . Print name: 2L2 t� Z �^� Date: G_ )� _) This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 4404616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information O 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 Valuation: Permit 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 Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to P 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 Baptistry/Font ❑ Any new commercial building with water service 2" and 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 Drive Thru as defined in OAR918- 780 -0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ 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 ❑ 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