Permit CITY OF TIGARD PLUMBING PERMIT
IN a COMMUNITY DEVELOPMENT Permit#: PLM2014-00173
TI G A. D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/28/2014
Parcel: 2S112CC03601
Jurisdiction: Tigard
Site address: 8030 SW CHURCHILL CT
Project: SMIRNOV Subdivision: BOND PARK NO.3 Lot: 64
Project Description: Installing(2)backflow preventers for irrigation,
Contractor: OWNER Owner: SMIRNOV,ALEXANDER
ALEXANDER SMIRNOV 8030 SW CHURCHILL CT
8030 SW CHURCHILL CT TIGARD,OR 97224
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 05/28/2014 $62.54
Specifics: 1 12%State Surcharge- 05/28/2014 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 05/28/2014 $9.96
Plumbing
Class of Work: ALT
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 ••• 101-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.806
r
Issued By: Permittee Signa ' -. __
Call 503.639.4175 by 7:00 a.m.for the next available pection 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 OCI��� Received FOR OFFICE, USE ONLY
City of Tigard Permit No.:a NV MI
.r 13125 SW Hall Blvd.,Tigard,OR 97223 re t
Phone: 503.718.2439 Fax: 503. Q O Plan Review
To
D Other Permit No.:
g� ` Date/By:
TIGARD Inspection Line: 503.639.4175 N ,��� Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov i y O* t a(�N Notified/ hod: �6, Supplemental Information
TYPE OF VJOR "1 ,. �k}�'
FEE* SCHEDULE
❑New construction emolition For special information use checklist
Description 1 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
® I-and 2-family dwelling C]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:8030 SW Churchill Ct Catch basin or area drain 18.76
18.76
Page 2
City/State/ZIP:Tigard OR 97224
Footing drain(no.linear ft.: )
Suite/bldg./apt.no.: I Project Warn ac f I, L Drywell,leach line,or trench drain
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 2 31.27 62.54
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
install pressure vacuum breaker on one connection to irrigation system Dishwasher 25.02
install Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Alexander Smirnov
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:8030 SW Churchill Ct
Garbage disposal 25.02
City/State/ZIP:Tigard OR 97224 Hose bib 25.02
Phone:(503)7700130 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: U1.vNC f Water P8/
r P in DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 62.54
Phone:( ) Fax:( ) Minimum permit fee: $72.50 T
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) Zv
Authorized signature: TOTAL PERMIT FEE aO
Print name: Ageica bid e r I./t ,,,�pc, Date: 3-77 a 9 l y This permit application expires If a permit is not obtained with 180 days
i / `` l( 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(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- I' 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 1/2/2 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.Performed: Capped Added Relocate 9 y g'
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.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
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"
4„ Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
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 permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\asmirnov\Downloads\20I 402_backflow_PLM U-PermitApp(1).4c
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
1 I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
flielcci(4 cl er ,c144,rbo v
Print Name of Permit Applicant
V28/i'
Signa ure of Permit Applicant Date
Permit#: ar►r1cab1 '1— do I 7 3
Address: rd3C7 Sc.J l� .
�It ,1/ a
Issued by: 8 f . Date: 51111/1
This Copy for Permit Offices
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
8030 SW CHURCHILL CT, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00173
George Heimos
Violation Summary:
Inspector Contractor