Permit •
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00186
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2013
Parcel: 1 S135BB00800
Jurisdiction: Tigard
Site address: 10655 SW GREENBURG RD
• Project: Ewing Irrigarion Subdivision: HILLSBORO Lot: PTS 1 -2
Project Description: Installation of double check valve
Contractor: OREGON UNDERGROUND INC Owner: EWING IRRIGATION PRODUCTS INC
PO BOX 777 3441 E HARBOUR DR
CLACKAMAS, OR 97015 PHEONIX, AZ 85034
PHONE: 503 - 657 -6123 PHONE:
FAX: 503 - 656 -2061
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/12/2013 $31.27
Specifics: 1 12% State Surcharge - 06/12/2013 $8.70
Plumbing
Type of Use COM 41 ea Minimum Fee Adjustment - 06/12/2013 $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
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 Notifi - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direc • uestions to OUN • - ' g 503.232.1987 or 1.800.332.2344. /
Issue. By: / ` PermitteeSignature: 7 t -
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
Site Utilities FOR OFFICE USE ONLY
City of Tigard Date/By: / ff��/ Permit No.: L J p
-
q 13125 SW Hall Blvd., Tigard, OR 97223 ae /B : ((/ Lr /plci(� "'��OD
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit No.:
T I G A R D 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
F or special New construction ❑Demolition ecial in ormation use checklist. P
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 (I) bath 312.70
❑ I- 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: 10655 SW Greenberg rd. Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard Fooling drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: I Project name: Lamphere Building Manufactured home utilities 50.03
Cross street/directions to job site: Just off 217 (South side) Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear It.: ) 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.: Backllow preventer I 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
New Double Check Installation Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Ewing Irrigation 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
❑ APPLICANT ❑ CONTACT PERSON 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: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Oregon Underground, Inc., Water piping/DWV 56.29
Address: P.O. Box 777 Other: 25.02
City /State/ZIP: Clackamas Subtotal
Phone: (503) 657 -6123 Fax: (503) 656 -2061 Minimum permit fee: $72.50 ` ?.
CCB Lie.: 116182 i 114 Plumbing Lic. no.: 3 -541 PB Plan review (25% of pennit fee)
7/ ` /lc( State surcharge (12% of permit fee) ! 40
Authorized si TOTAL PERMIT FEE % (,
Print name: Tom Rasch Date: 6/12/13 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
•Fee methodology set by Tri- County Building Industry Service Board.
1: \ Building \ Permits \PLMU- PermitApp.doc 10/01/09 440 -4616T( I0 /02 /COM /WO13)
q
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V
Request Permit Action 7//5-A5 -
q :
=rl,G>A;R-D. 13125 SW Hall Blvd • Tigard, Oregon 97223 • 503 718 2439 • www tigard-or gov
TO CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd,Tigard,OR 97223
Phone 503 718 2430 Fax 503 598 1960 www tigard-or gov
FROM El Owner ❑ Applicant El Contractor CR City Staff
(check one)
REFUND OR Name N
INVOICE TO (Business or Individual)
Mailing Address
City/State/Zip
Phone No
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1)
[ ]- CANCEL/VOID PERMIT APPLICATION
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below)
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below)
El REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit)
Permit# LM 9\01 - O o I V O
Site Address or Parcel # (( (p 5 5 V Q€i I 6a-ekeo Q-D
Project Name L tJl-� ���l j�l / n�
Subdivision Name lV /}- Lot# )J/-
EXPLANATION cT�� p�Co t' O N orr o f r,84._
(0 k Ot LN i
7 6OOg't
Signature Date 7/ //J
Print Name ✓OP1i__ P1-1 Prl�-t5/��
Refund Policy
1 The Director or Building Official may authon7e the refund of
a) any fee which was erroneously paid or collected
b) not more than 80%of the land use application fee when an apphcation is withdrawn or canceled before any review effort has been expended
c) not more than 80%of the land use application fee for issued permits
d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended
e) not more than 80%of the building permit fee for issued permits prior to any inspection requests
2 Refunds will be returned to the original Payer in the same method in which payment was received Please allow 2 4 weeks for processing refunds
FOR OFFICE USE ONLY
Rte to S s Admen Date 7 fi®EMIM Rte to Bid:Admtn Date 'AM= B ,f7
Refund Processed Date MEM G_ B Invoice Processed Date B
Permit Canceled Date 7/ZS i3 By ��� Parcel Tag Added Date By
Receipt# Date Method Amount$
I\Building\Forms\RegPermrtAction doe Rev 05/25/2012
Application
�So'�o/3-ab08c
Plumbing Pe rmit
Site Utilities FOR OFFICE USE ONLY
City of Tigard Received (�� / Pennil No rp
a 13125 SW Hall Blvd Tigard OR t,.. 3 Phn Review
C • Phone 503 718 2439 Fax 5til,'' ''I:i�, • Date/By Other Permit No
T 1 G A k D Inspection Line 503 639 4175 Due Ready/By rwo RI See Page 2 for
Internet www tigard-or gov NoufiediMelhod Supplemental Informnhon
TYPE OF WORK FEE" SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty I Ea I Total
®Addition/alteration/replacement ❑Other New 12 fancily dwellings(includes 100 B for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312 70
❑ 1 and 2 family dwelling ®Commercial/Industrial SFR(2)bath 437 78
SFR(3)bath 500 32
❑Accessory building ❑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 10655 SW Greenberg rd Catch basin or area drain ]8 76
Drywell leach line or trench drain 18 76
City/State/ZIP Tigard
Fooling drain(no linear ft �) Page 2
Suite/bldg/apt no I Project name Lamphere Building Manufactured home utilities 50 03
Cross street/directions to job site Just off 217(South side) Manholes 18 76
Rain drain connector 18 76
1 ^ Sanitary sewer(no linear 11 _) Page 2
�J l Storm sewer(no linear ft _) Page 2
( Water service(no linear ft _) Page 2
Subdivision I Lot no Fixture or teem
U Tax map/parcel no Backflow preventer I 31 27
1 DESCRIPTION OF WORK Backwater valve 12 51
1\ Clothes washer 25 02
Vim' Dishwasher 25 02
New Double Check Installation Drinking fountain 25 02
Ejectors/sump 25 02
® PROPERTY OWNER 1 0 TENANT Expansion lank 12 51
Name Ewing Irrigation
Address ,Fixture/sewer cap 25 02
Floor drain floor sink/hub 25 02
v^, Garbage disposal 25 02
City/State/ZIP Hose bib 25 02
Phone ( ) Fax ( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25 02
Business name Medical gas(value 5_) Page 2
Pruner 12 51
Contact name
i 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 Oregon Underground,Inc Water piping/DWV 56 29
Address P O Box 777 Other 25 02
City/State/ZIP Clackamas Subtotal `�
Phone (503)657-6123 Fax (503)656-2061
Minimum permit fee S72 50 7 7
CCB Lie 116182 g l(N�1 ? Plumbing Lic no 3 541PB Plan review (25%of permit fee) e.-
7/r//� State surcharge(12%of permit fee) CI al
Authorized signature TOTAL PERMIT FEE %)
Print name Tom Rasch Date 6/12/11 I Ms permit application expires if a permit k not obtained within IRO days
after it has been accepted as complete
lee ineihodoloty set by l ri County Building Industry Service Board
I tau Id ngiPerm a\PLMU PmmttApp doe 10/01/0q f 440-4616T(torovcomiwrn)
A
' r
City of Tigard
13125 SW Hal Blvd
Tigard, OR 97223 Tel 503 718 2439
Location Inspection Date
10655 SW GREENBURG RD, TIGARD, OR, 06/19/2013 00 00
97223
Record Type Record ID
Commercial - Plumbing PLM2013-00186
Inspection Type Result
399 Plumbing final CNCL
- —Comments
NOTE Permit is a double check for a fire line not potable water, needs new permit
issued
4ti
Violation Summary
Inspector Contractor
y1 ,
}
a5
F S
1�
fl
i
S !F L
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10655 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
06/19/2013 00:00
PLM2013-00186
CNCL
NOTE. Permit is a double check for a fire line not potable water, needs new permit
issued.
Violation Summary:
Inspector Contractor