Permit CITY OF TIGARD PLUMBING PERMIT
ii INI- 2 • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00247
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2013
TIGARD Parcel: 1 S133CA09200
Jurisdiction: Tigard
Site address: 13682 SW ROSEMARY LN
Project: Village at Summer Creek, Lot 15 Subdivision: VILLAGE AT SUMMER CREEK Lot: 15
Project Description: Irrigation backflow device.
Contractor: ASHLAND BROTHERS LANDSCAPES Owner: CENTEX HOMES
2153 MOLALLA HIGHWAY 11241 SLATER AVE NE STE 100
WOODBURN, OR 97071 KIRKLAND, WA 98033
PHONE: 503 - 981 -6131 PHONE:
FAX: 503 - 981 -1058
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/23/2013 $31.27
Specifics: 1 12% State Surcharge - 07/23/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 07/23/2013 $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 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: Permittee Signature: � < . / 9 ���0„ /
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.
Jul 19 13 09:28p Ashland Brothers 503- 981 -1058 p.1
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Plumbing Permit Applie . h i ` -,,t
Site Utilities IV _ . - • roll �Irl,( 1. t SL ()Nix . of Tigard � 2 2
fleoervcd i�
• 1 11 1 SW Hall Blvd.. Tigard, OR 9 2U13 Pie : / R 3 f 3 1 r r Pe rmit Nottoay�i3 00,2 y , t
It Phone: 503.718.2439 Fax 503
Date/By:
Other Permit 57,z042 o 61.29 `
Inspection Line: 503.634.4175 �F TIG�►RD DateReady/By: �/ El See Pa m gez for
rl n Internet www.tigard-or.gov
BUILDING DIVISION Notified/Melhod: v Sapplecotaf
TYPE OF WORK FEE* SCHEDULE it
❑ New construction 0 Demolition
For special information use ckc'vrtst it
Description I Qty. I Ea. I Total il
❑ Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection) 1 I
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 it
❑ 1- and 2- family dwelling 12 Commercial/industrial SFR (2) bath 437.78 ;i
SFR (3) bath 50032 1,
❑ Accessory building El Multi- family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 11
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ) -- .2 ) 4, g 2 51...3 � o ,,
yt , Q Catch ll, in ch orea drain to 18 76
i- _ "-" � " Drywall, leach line, or trench drain 18.76 I;
City/State/ZIP: j 5 a , y � d q ..2.3 Li Footing drain (no. linear ft: ) Page 2
i.
Suite/bldg. /apt.no.: Project name: S 1/1 -% ems t .'CGK Manufactured home utilities 50.03 - I
Cross street/directions to job site: -� . Se .). .S i.4 Manholes 18.76
Rain drain connector : 18.76 1 1
A V SOWS Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) Page 2 !'
Water service (no. linear ft.: 1 Page 2
Subdivision: Suf -✓ Cre,e.t,- I Lot no.: (1 Fixture or item: li
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51 L a� rj t j
Clothes washer 25.02
54-a1-2-- I
- --. .c y) Ii V..,\ > Dishwasher 25.02 11
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 1251 ,
Name: Fixture/sewer cap l 25.02 II
Floor drain/floor sink/hub 25.02 1j
Address Garbage disposal 25.02 it
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51 II
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: S ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51 '
•
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable wafer) 62.54 11
Phone: ( )
Fax: : ( ) Tub /shower/shower pan 12.51
E-mail: Urinal 25.02 ii
Water closet 25.02 i
CONTRACTOR
Water heater 37.52
Business name: i4 Q (IL SVC7r1.e vs LI Ii d'..,C_u.p GS, Water piping/DWV 56.29
Address: 1 . C - a I 3 V Other. 25.02
City/State/ZIP: L, p A .1).. ) ,„ 6 „, ( 6 '" 1 ^ Subtotal I . 51
5 ) J ( I 0 r --p , Minimum permit fee: $72.50 42 ,
Phone: (�� 6� f Fax: Plan review (25% of permit fee)
CCB Lic.: I /11 30M Plumbing Lic. no.: - State surcharge (12% of permit fee) (B . Q ,
Authorized signature: T� TOTAL PERMIT FEE l
J This permit application expires if a permit o not obtained within 180 days '
I Print name: Date: ci I,
�� R �s1g � j'� l after it has been accepted or complete.
*Fee methodology set by Tri- County Building Industry Service Board.
�'t 0 ]t i
1:1Building\PermilsIPL� pS 1t PermiiAppdoe 1(101/09 440- 4616T(10/07/COWNE6) G/r
Jul 19 13 09:28p Ashland Brothers 503- 981 -1058 p.2
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i
Plumbing Permit Application - City of Tigard i j
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppr ession Systems: ;:
Site Utilities Qty. FeO (ea) Tel Square Footage: Cage: Permit Fee: • I,
Footing drain - l' 100' 50.03 0 to 2,000 $121.90 , i 1,
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 I
Sewer - 1st 100' 62.54 3,601 to 7.200 $233.20 � j
7,201 and greater $327.54
Sewer - each additional 100' 37.52 . i
Water Service - lst 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee: i
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
1.
Other Inspections or Fees Qty Fee (ea) Total eac 10
h additional or fraction thereof, to including 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 S379.50 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 S742.00 for the first $50,000.00 and S 1.20 for
(minimum charge -112 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
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is uired for any of the following.
Work Performed: Capped Added Relocate req Y nS
Baptistry/Font Please check all that apply. •
Bath Tub/Shower ❑ Any new commercial building with water service 2" and
-Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer. I;
-Drive Thin ❑ New exterior plumbing site utilities for any complex structure i;
Cuspidor /Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. •
- Domestic ❑ Any multipurpose fire sprinkler system. •
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3
Isometric or. Riser Diagram
Car Wash Drain ❑ Isometric or riser diaam is required for new buildings
Garbage - Domestic- non -food o gr 9 &s
Disposal - Domestic -food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains •
Oil Separator [Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang •
-Stall
Sink/lav - Non -food related
- Bradley
- Commercial- food related
-Service
Swimming Pool Filter *Note: If the fixture work under this ermit results in an
Washer - Clothes p
Water Extractor increase of sewer Mills,
s , a sewer permit will be issued and
•
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
il
Urinal plumbing permit can be issued. 1
Other Fixtures:
I
http J /www.tigard- or.gov/ city _hall /departments/cd /docs(PLMU- PermitApiadoc
1�I GARD
City of Tigard
October 15, 2013
Ashland Brothers Landscape
Attn: Thomas N Ashland
PO Box 130
Woodburn, OR 97071
Re: Permit No. PLM2013-00247
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13682 SW Rosemary Ln
Project Name: Village at Summer Creek,Lot 15
Job No.:
Refund Method: n Check # in the amount of$
E Credit card "return" receipt in the amount of$64.96.
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
n Trust account"deposit" receipt in the amount of$
Comment(s): Per applicant's request as "no irrigation on it, it's a common irrigation".
Refund 80% of permit fees.
If you have any questions please contact me at 503.718 2430.
Sincerely,
totti _
Dianna Iowse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
-
- r City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request Jor Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Ashland Brothers Landscape DATE: 10/15/2013
Attn: Thomas N Ashland
PO Box 130 REQUESTED BY: Dianna Howse
Woodburn, OR 97071
TRANSACTION INFORMATION:
Receipt#: 192359 Case #: PLM2013-00247
Date: 7/23/2013 Address/Parcel: 13682 SW Roemary Ln
Pav Method: CreditCard Project Name: Village at Summer Creek Lot 15
EXPLANATION: Per applicant's request as "no irrigation on it,it's a common irrigation". Refund 80% of
permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plumbing permit 230-0000-43101 $58.00
12''o State Surcharge 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIGNA ES DATE:
If under$5,000 Professional Staff (.11-e—
If under S 12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: lO//s`/-3 By:
I:\Budding\Refunds\Rcfundltcyucsc.doc x 119/I11/2UIII
Aug 20 13 08:16p Ashland Brothers 503-981-1058 p.1
RECEIVE?
Tigard • COMMUNITY DEVELOPMENT DEPARTMENT AUG 2 0 2013
Wil "I'1
caty of g
Request Permit Action CITY OFTIGARD q • ,, DIVISION
TIGARD
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439• w_�v�v.ti
CITY OF TIGARD
TO: Division Services Supervisor
Building ing Jd��S/�3
13125 SW Hall Blvd.,Tigard,OR 97223 www.ti d or.gov
Phone: 503.718.2430 Fax: 503.598.1960
FROM: [] Owner Applicant
❑ Contractor ❑ City Staff
(check one)
REFUND OR Name: _ `l�l -r `XJS
INVOICE TO: (Business or individual) /l t7 G r
Mailing
Address: _L).:____ :a_c ---' J —
City/State/lip: 0 U './ '/r 5
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
•
•
❑ CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and providexplanation
below).
INVOICE FOR FEES DUE(attach case fee schedule and provide e p
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not ca permit).
.. P tI o/3_d0,29 7
t#: �/ p — ' ,/ _'��ANfir
Permit /110
- -
Site Address or Parcel#: -, + • :2) JP •
Project Name: ( "I;'1 '-X'
C, v r l.` Lot#. °�
Subdivision Name: Du O V v
EXPLANATION: Ail a t'.c V�?-�-,�1,-1L ( C..✓. 1�(r C L•`_ - )�0
i ii v �5G,4,,v,\ f �a 1 rf > /^
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.
Signature: T
Print Name: -77-772:-. i CS-70:/-9-,9 1
Refund Pn)iq
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 8tr'of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. ,
c) nor more than 804 n 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 ant plan renew effort has been cepcnded.
e) nor more than 80`"'n of the building permit Ice 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.
I OR ®F1 ICE USE ON,I.�
Rte to Sys Admin: Date By Rte to Bldg Admin: Date/0 /5
Refund Processed: Date/d//S�/3 By Invoice Processed: Date By
Permit Canceled: Date /4/S43 B)4— Parcel Tag Added: Date By
Receipt# Date Method ,
Amount$
l.•\Building\Forms\RegPcrmitAetion.doc Rev:05/25/2012
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