Permit (103) IL CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00031
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/31/2017
TtC�"' � g Parcel: 2S112C600500
Jurisdiction: TIGARD
Site address: 8240 SW NORFOLK LN
Project: Hoggans Park,Lot 9 Subdivision: HOGGAN'S PARK Lot: 6
Project Description: Backflow preventer for irrigation.
Contractor: ALL METRO LANDSCAPE Owner: WESTWOOD HOMES LLC
PO BOX 1812 12700 NW CORNELL RD
BEAVERTON, OR 97075 PORTLAND, OR 97229
PHONE: 503-481-4732 PHONE:
FAX: 503-372-9162
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/31/2017 $31.27
Specifics: 1 12%State Surcharge- 01/31/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 01/31/2017 $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 require ou to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952 101-0090. You may obtain a copy of he rules
or direct questions to OUNC by calling 503.232.1•: •• 1.800.332.2344.
Issued By: / 4111P
` Permittee Signature:
4
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 p oject.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures IN
Cityof Tigard , - , �) Received
g ,-A Date/By: ! 5/ t 7 PermitNo.: /0//771.26/7....0(1-5 /
lig • 13125 SW Hall Blvd.,Tigard,OR 97- �i 1
Plan Review
Phone: 503.718.2439 Fax: 503.598: Other Permit No.:
1 Date/By: �iST is--00-s61
Inspection Line: 503.639.4175 .
T 1 G A R D 1 /. t. Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov 1� VtNotified/Method: 7" --G, Supplemental Information
TYPE OF WORK t'®�a L ' r041 FEE* SCHEDULE
1ErIvew construction T151.
El Deo t For special information use checklist
t �
Description Ea. Total
t '„f� I I
0 Addition/alteration/replacement 0 O' � New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
p--I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑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
JOB SITE`INFORMATION AND LOCATION Site utilities:
Job site address: q';" r Catch basin or area drain 18.76
L-`�� 5w NC��-v( � G. v�
City/State/ZIP: --41 ,P q) 9-41 Drywell,leach line,or trench drain 18.76
1 ty �7 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1
1 1-t,t /POs 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 31.27 3 7
h* x`"'' DESCRIPTION OF WORK .; Backwater valve 12.51
:- -- � x Clothes washer 25.02
C?)Ck-LEi�`l°GA-1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY-ER 1 ti TENANT Expansion tank 12.51
Name: �/`�LS )e CJ, 1-4-c tis Fixture/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
0 APPLICANT LI +)NTACT PEitSO Interceptor/grease trap 25.02
Business name: it l( NA8 v LQ 1,,4 5 c4--\0„- c_. Medical gas(value:$ ) Page 2
Contact name: -'-ti i'In t,v Primer 12.51
v v Roof drain(commercial) 12.51
Address: f G 6e> t (Z
Sink/basin/lavatory 25.02
City/State/ZIP: 5 zca t„e y iripv-‘ 0.. '1-7 c --i 5 Solar units(potable water) 62.54
Phone:(`}13) \.p,,( Le-13Z_ Fax::( ) Tub/shower/shower pan 12.51
E-mail: atlye-.e._ ,.c, i`IA,_e c.,, ,,_, s( . 1, +-
Urinal 25.02
n.; CONTRACTOR s Water closet 25.02
- ;�. , Water heater 37.52
Business name: 5 c.VA-- 2__. Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: / L C_f 3 "1 el d t Subtotal "3/ -1
Phone:( ) Fax:( ) Minimum permit fee: $72.50 -2) sv
CCB Lic.: e",../‘ Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) T--A)
Authorized signature: TOTAL PERMIT FEE g"j,d-c)
Print name: \12.....-r.-v r' vs, 1., J U Date: This permit application expires if a permit is not obtained within 180 days
iNiafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:ABuilding VPermits\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. ) Total Square Footage: Permit Fee:
Footing drain-151 100' 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
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 Fee{ea) Total each additional$100.00 or fraction thereof,to
h 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- pr Plum- Instillations
Quantity by Fixture e Plan review is required for any of the following.
Fixture Type for Re's Please check all that apply.
Work Performed: Capped Added Relocate-
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 0 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" ,, F
3" Isomeric or Rit si lagram
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
8240 SW NORFOLK LN, TIGARD, OR, 97224
Record Type:
Residential - Plumbing
Inspection Type:
399 Plumbing final
Result:
PASS- NoCofO
Comments:
Tel: 503.718.2439
Inspection Date:
Record ID:
PLM2017-00031
Inspector:
Don Sylvester
1. 1" Wilkins DC model 350, serial # A559815, for irrigation, located by water meter, - ok
with test.
Violation Summary:
Inspector Contractor