Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013 -00207
Date Issued: 06/26/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S104D605600
Jurisdiction: Tigard
Site address: 13231 SW MAPLECREST CT
Project: Maplecrest, Lot 3 Subdivision: MAPLECREST Lot: 3
Project Description: Install residential backflow preventer for irrigation
Contractor: BURNESS LANDSCAPE Owner: RICHARDS, M DALE
8630 SW SCHOLLS FERRY RD ADAMS, HEATHER M
BEAVERTON, OR 97008 12655 SW NORTH DAKOTA
TIGARD, OR 97223
PHONE: 503 - 572 -0009 PHONE 503-780-4375
FAX: 503 - 432 -8525
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/26/2013 $31.27
Specifics: 1 12% State Surcharge - 06/26/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 06/26/2013 $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 • • - ion Gen - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. Ybu may ob -in a copy of the rules
or .' -ct questions to OUNC oy . 503 232.1987 or 1 800 332.2344.
ssued By: 4 , 1 , Permittee Signature:
• Call 503.639.4175 by 7:00 a.m. for the next available insp= tion dat'.
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 RECEIVED I FOIL OFFICE USE ONLY
City of Tigard DateByd IP ,:: 3 ,I Permit No Il Lki l .a0/3 7/0267
n 13125 SW Hall Blvd., Tigard,OR 97 (�l 2 203
to Phone: 503.718.2439 Fax 503.59 0 6 Date/By Review Other Permit No..
Inspection Line: 503 639.4175 D ate Ready/By Juns ® See Pa e 2 for
TIGARD CITY y y g
Internet: www tigard- or.gov Notified/Method Supplemental Information
- , TYPE OFBiARING DIVISION FEE* SCHEDULE
New construction ❑ Demolition For special information use check list:
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
It(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: Firc sprinkler (. sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /3 g 3 I S t,{ c� W het �� v
, / I- Catch basin area dram 18.76 / t
City /State /ZIP: Dr ell, leacch h line, or trench drain 18.76
J �� � , Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Ai (
Ur ell- Manufactured home utilities 50 03
Cross street/directions to job site: Manholes 18.76
r r Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear 8.. ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12 51
r I Clothes washer 25 02
I n T IBL✓ r te.SLI( Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ 'PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixturc /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
121 APPLICANT ❑ 'CONTACT PERSON Interceptor /grease trap 25.02
Business name: L�viri &a_ �A. y.JSI � p C
Medical gas (value: $ ) Page 2
i Primer 12.51
Contact name: i o
Roof drain (commercial) 12.51
Address: O c 1 c c,../ 7 ��
,1 l s f:eyty 0 Sink/basin/lavatory 25.02
City /State /ZIP: 1.0 G vc ,/ i 5 Q 00 g Solar units (potable water) 62 54
Phone: (D)1 ) ■_l 13 1....
. S" . , Fax. . ( ) ,E Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25 02
CONTRACTOR
c � ' Water heater 37 52
Business name r d?v /'✓lail ), tnC S[tyLL.J vtc Water piping/DWV 56.29
Address: too 5c„, 3,1,,tts 1V u Other: 25.02
City /State /ZIP: I 1 I epos Subtotal �
/ Minimum permit fee. $72.50 A-
Phone: (Sb) ) 43) - a ] F ax: (Sb1 ) Y. / a , F :u
CCB Lic.: tqc) 7 Plumbing Lic. no.: Plan review (25% of permit fee) . —
State surcharge (12% of permit fee) e. 26
Authorized signature: TOTAL PERMIT FEE 87 ,
Print name: Date: b . 26, 0
This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
I \ Budding \Pennits\PLMU- PermitApp doe 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 Qty. - Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1 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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall 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
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