Permit (18) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00380
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/14/2016
Parcel: 2S 103 DA04300
Jurisdiction: Tigard
Site address: 10660 SW PARK ST
Project: Arreola Subdivision: FANTASY HILL Lot: 4
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: JESSICA&LUIS ARREOLA Owner: ROSALES, LUIS ARREOLA
10660 SW PARK AVE ARREOLA,JESSICA
TIGARD, OR 97223 10660 SW PARK ST
TIGARD, OR 97223
PHONE: 503-890-8911 PHONE: 503-890-8911
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/14/2016 $31.27
Specifics: 1 12%State Surcharge- 07/14/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 07/14/2016 $41.23
Class of Work: OTR Plumbing
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 qu- OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: / Permittee Signature: AFL
Call 503.639.4175 by 7:00 a.m.for the next available inspection .ate. dr.
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 . t ► ` t 4i':' " t w FOR OFFICE USE ONLY
Receiv
City of Tigard Date/By: 7 /y /(� ��j Permit No.:i M //0.�3 Oe'
a 13125 SW Hall Blvd.,Tigard,ORI 0231 4 2016v
9 Plan Review
Phone: 503.718.2439 Fax: 503.598 1960 Date/By: Other Permit No.:
T 1 C;A R Inspection Line: 503.639.41'6i-1. i , Date Ready/By: Juris: ® See Page 2 for
Internet: www tigard or. U f t[)N I .7:‘,0,‘,15;i r,y, Notified/Method: Supplemental Information
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0 New construction 0 Demolition For special information use checklist
Description Qty. Ea. 1 Total
0 Addition/alteration/replacement ®Other:Backflow New 1-2-family dwellings(includes 100 ft.for each utility connection)
' rt� Iit'11 CIS ltTt:rTlilvSFR(1)bath 312.70
SFR(2)bath 437.78
01-and 2-family dwelling 0 Commercial/industrial
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other;
Fire sprinkler( sq.ft.) Page 2
. JO ° "lT ORt 11A M. AND LOCATION: . .4 Site utilities:
Job site address:10660 SW Park St. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 --.--- -- --- _
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site:Park St./Watkins 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.: Fixture or item:
Tax map/parcel no.: Backflow preventer x 31.27
IIE `RI^'UON Qt :WOE ' ,
Backwater valve 12.51
Clothes washer 25.02
Installation of Irrigation system.(Backflow) - - -
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
-iiiiiPEIt1`1 WN R �j Expansion tank 12.51
Name:Jessica and Luis Arreola Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:10660 SW Park St.
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)890-8911 Fax:( ) Ice maker 12.51
APIIIAIif { bIaA PEii43N 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
N'T ,0Ot#
Q � Water heater 37.52
Business name: 0/-0/0 e/2 Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax: ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 'lambing Li ono.:
State surcharge(12%of permit fee)
. .,6.,„
Authorized signa e: TOTAL PERMIT FEE 81.20
Print name:Jessica A /4(--
V
Date:7/14/16 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\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:
t ��lit t I tat ,-Soot e,Foot : lel
Footing drain-1s`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 «
V1 att ll P
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
each additional$100.00 or fraction thereof,to 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_(ninimum 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*.
(uantity bv. ixtu #ape ` R� 1� # 11Kst l tifl,>€1
fixture Type f°r . '" Plan review is required for any of the following.
WorT Perforured: Capped. A Relocte,
Please check all that apply.
Baptistry/Font
Bath -Tub/Shower 0 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 0 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 0 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" I il� �r elr i
raw,
Car Wash Drain
Garbage -Domestic-non-food L-1Isometric 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
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\Arreola\AppData\Local\Temp\PLMU_PermitApp.doc 2
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
10660 SW PARK ST, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00380
Don Sylvester
Violation Summary:
Inspector Contractor