Permit 1y is CITY OF TIGARD PLUMBING PERMIT
1111 s COMMUNITY DEVELOPMENT Permit#: PLM2014-00249
Date Issued: 07/30/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S108AB04800
Jurisdiction: Tigard
Site address: 13943 SW 155TH TER
Project: Brentwood Estates. Lot 10 Subdivision: BRENTWOOD ESTATES Lot: 10
Project Description: Installation of residential backflow preventer for irrigation
Contractor: MERTEN AND SON'S LANDSCAPE Owner: BRENTWOOD HOMES
PO BOX 261 17500 SW CAESAR TERRACE
SAINT PAUL, OR 97137 TIGARD, OR 97224
P
PHONE: 503-407-1101
HONE: 503-209-5159
FAX:
FEES
Quantity Description Date Amount
ea Backflow Preventer 07/30/2014 S31 17
Specifics: 1 12%State Surcharge- 07/30/2014 58.70
Plumbing
41 ea Minimum Fee Adjustment- 07/30/2014 $41.23
Type of Use: SF Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total 581.20
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:
1.1211111.- --
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 ApplicaECEIVEI)tion
Building Fixtures JUL 3 0 2014 FOR OFFICE. I'SF ONI.l'
City of Tigard Date/By: I 1 ( r7Nl� -6.
N + + Received ? 7jC ! Permit No.: L J
13125 SW Hall Blvd.,Tigard,01Cl OF TIGARD Plan Review
• • Phone: 503.718.2439 Fax:MIMIC DIVISION Date/By: Other Permit No.:t4r0e,/ c,/D9
T I G A R D Inspection Line: 503.639.417 Date Ready/By: Juris 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE' SCHEDULE
jkNew construction ❑Demolition For special information use checklist
Description [ 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
Fi1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
ry 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: 3 tj l s J 5. st-oxe Catch basin or area drain 1 8.76
City/State/ZIP: t �'r (tJ-t Drywell,leach line,or trench drain 18.76
City/State/ZIP: � CP 9 ` 223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 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: Lot no.;/6 Fixture or item:
Tax map/parcel no.: Backflow preventer I 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/ /, Clothes washer 25.02
.j'r(134)1irI1 Dtif:`C DO: Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sirk/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
� f Medical gas(value:$ ) Page 2
Business name: Y - 44d( _Ce,rw5• / �i� ,,�
Contact name: Ze t LJ a I _. i "'^`?' Primer 12.51
I � �� t'LJ Roof drain(commercial) 12.51
Address; P ll�]7C z4 I Sink/basin/lavatory 25.02
City/State/ZIP: 54.1 p I rkr 1713, Solar units(potable water) 62.54
Phone:503 " ? S-is 9 1 Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
h� Water heater 37.52
Business name: / 'Yts- oM 5o''. ! Water p i P m�WV 56.29
Address: U_o d f Other: 25.02
City/State/ZIP: 54;_i Py,� tt0 if 3y Subtotal
Phone:(So5) „5/�1 Fax:(I ) Minimum permit fee: $72.50 �a S�
COR-bit: 4 �1 Plumbing Lie.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) q.
Authorized signature: 4/05 TOTAL PERMIT FEE r.�Gl
Print name: ' eo( )kr- Date:i,i"Z/,r,14 This permit application expires if a permit is not obtained within 180 days
f V 1 after it has been accepted as complete.
iFee methodology set by Tri-County Building Industry Service Board.
:\Building1pennits\PLMU-PennitAppdoe 10/01/09 440-4616T(I0/OYCOM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty Fatten) T°tM' 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 5169.69
3,601 to 7,200 5233.20
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&Ram Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Ram 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 ) T each additional$100.00 or fraction thereof,to
p and including 510,000.00.
Inspection of existing plumbing or for 510,001.00 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 90.00lhr $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
Quantl!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 ❑ Any new commercial building with water service 2"and
Baptistry/Font 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
Each Stall as defined in OAR918-780-0040.
Cuspidor/Water
-Drive T ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose tire 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
-Corn/Serv/Util food related _
-Service *Note: lithe fixture work under this permit results in an
Swimming Pool Filer 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
WaterCloset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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