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Permit (159) CITY OF TIGARD PLUMBING PERMIT ,111 COMMUNITY DEVELOPMENT Permit#: PLM2017-00062 T r r;A I?.i- 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/28/2017 Parcel: 2S 110BA10900 Jurisdiction: TIGARD Site address: 14080 SW 118TH CT Project: Medallion Meadows,Lot 2 Subdivision: MEDALLION MEADOWS Lot: 1 Project Description: Installation of residential backflow preventer for irrigation. Contractor: SUMMIT LANDSCAPE LLC Owner: JT ROTH CONSTRUCTION INC PO BOX 3610 FOUR D CONSTRUCTION CO HILLSBORO, OR 97123 12600 SW 72ND AVE#200 TIGARD, OR 97223 PHONE: 503-380-7618 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 02/28/2017 $31.27 Specifics: 1 12%State Surcharge- 02/28/2017 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 02/28/2017 $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• -- .• to OUNC by calling 503.232.1987 or 1.800.332.2344. Issue, By: / Permittee Signat 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 Application Building Fixtures t ( , 3" w FOR OFFICE LSE ONE) City of Tigard 11 n ) Received s/ /7 , 13125 SW Hall Blvd.,Tigard,OR 972231111 Plan Date/By: - Permit No.: � �r 7 0�&p, _ Phone: 503.718.2439 Fax: 503.598.k96(ji2016 Date/By: Inspection Line: 503.639.4175 Other Permit No.:1`('7T 5"--4002.•2„ T I G A R D Date Ready/By: lb( Internet: www.tigard-or.gov r . kis. I Supplemental See Page 2 for £ i ,e Notified/Method: Information TYPE OFBOXICHN.E 11i I q;r'iv FEE* SCHEDULE &New construction ❑Demolition For special information use checklist ID Addition/alteration/replacement Description Qty. Ea. � Total ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION, SFR(1)bath otl-and 2-family dwelling 0 Commercial/industrial SFR(2)bath I I 437.78312.70 I ❑Accessory building ❑Multi-family SFR(3)bath 500.32 ❑Master builder Each additional bath/kitchen 25.02 ❑Other: Fire sprinkler( sq.ft.) Pae 2 JOB SITE INFORMATION AND LOCATION " g Site utilities: Job site address: t goA? s-, //s-71-- Catch basin or area drain 18.76 City/State/ZIP: 'G,L..- 04 1 7 Drywell,leach line,or trench drain 18.76 I Suite/bldg./apt.no.: J I Project name: Footing drain(no.linear ft.:_) Page 2 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 Subdivision: Water service(no.linear ft.: ) Page 2 I Lot no.: e� Fixture or item: Tax map/parcel no.: Backflow preventer , . � .. 31.27 DESCRH'TION'OF ORK` Backwater valve 12.51 / GkFic t.3 7-h--S 7 .t Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 pR+OI'EERTY OWNER :, ,. I ;+ 0 TENANT Expansion tank 12.51 , I Name: ., p Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 City/State/ZIP: Garbage disposal 25.02 Phone:( ) Hose bib 25.02 Fax:( ) ielss . -�"'�", - ICANT��. r - .. R�� . ... Ice maker..... IS 02 ❑.CONTACT PERSON. Interceptor/grease trap 2 Business name: Medical gas(value:$ ) Page 2 Contact name: Primer 12.51 Address: Roof drain(commercial) 12.51 City/State/ZIP: Sink/basin/lavatory 25.02 Solar units(potable water) 62.54 Phone:( ) I Fax: ( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 Water heater 37.52 Business name: 6dc p111C4 1 )CONTRACTOR tL bi a- 1/C e Wateri m DWV Address: c Jaz, / p p 25.0 Other: I 25.02 City/State/ZIP: i 44 Phone: a;"°.� r 3Subtotal (y t°,) jJ �,t Fax:( ) Minimum permit fee: $72.50 CCD L:,,.: L 4l .4 ft,s Plumbing Lic.no.: Plan review (25%of permit fee) Authorized signature: State surcharge(12%of permit fee) ». Y TOTAL PERMIT FEE 0!,84) Print name: `'� i,i )t -S l 54,../1 I Date: . $ l I 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. 1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-0616T(10/02/C.OM/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: 50.03 0 to 2,000 $121.90 Footing drain-l'100' 2,001 to 3,600 $169.69 Footing drain-each additional 100' 37.52 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' 37.52Valuati©ns 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 each additional$100.00 or fraction thereof,to Fee(ea) Total Other Inspections or Fees` Qty. 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. $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) 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*. flan Review for Plumbing Installation .;. Quantity 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 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 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" 3„ ,Isometric or Riser Diagram 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 Comments regarding fixture work: Ice Mach./Refrig.Drains 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 fees assessed for the sewer increase must be paid before the Water Extractor plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 14080 SW 118TH CT, TIGARD, OR, 97224 Record Type: Residential - Plumbing Inspection Type: 399 Plumbing final Result: PASS- NoCofO Comments: Tel: 503.718.2439 Inspection Date: Record ID: PLM2017-00062 Inspector: Don Sylvester 1. 1" Wilkins DC model 350, serial# A574133, for irrigation, located at left side of front yard - ok with test Violation Summary: Inspector Contractor