Permit (94) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00349
1 [ 7. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/30/2017
a
Parcel: 2S 110 BA 12900
Jurisdiction: Tigard
Site address: 14031 SW 118TH CT
Project: Medallion Meadows, Lot 22 Subdivision: MEDALLION MEADOWS Lot: 22
Project Description: Backflow preventer.
Contractor: AUSTIN BROWN LANDSCAPE Owner: JT ROTH CONSTRUCTION INC
PO BOX 14441 FOUR D CONSTRUCTION CO
PORTLAND, OR 97293 12600 SW 72ND AVE#200
TIGARD, OR 97223
PHONE: 503-887-7795 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/30/2017 $31.27
Specifics: 1 12%State Surcharge- 08/30/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/30/2017 $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 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 •b=i a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
/6./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 o:the pr. ect.
Approved plans are required on the job site at the time of each inspectio
Plumbing Permit Application
Building Fixtures
City of Tigard 'CFIVived ^� 9 -063
`J g v: a e/By: 0 3 6/� / � Permit No.:,L /�O f 7
III13125 SW Hall Blvd.,Tigard,OR 97223
_ Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:/.1/57k)/2 0,1 /
pI�i Date/By: -
T I G A R D Inspection Line: 503.639.4175 AUG 3 0 Z 01 Date Ready/By: Jars: ® See Page 2 for
Internet: www.tigard-or.gov T q Notified/Method:� Supplemental Information
TYPE OF WORK CITY FTIGARI) FEE* SCHEDULE
a
construction 1=1 DittittIDING DIVISION For special information use checklist.
Description Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION • SFR(1)bath 312.70
0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 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: 1 �( ° / Catch basin or area drain 18.76
City/State/ZIP: •--!�o/ /.. 7 C31, -.. Drywell,leach line,or trench drain 18.76
1 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: ,ioT .A.-t 0.....) Manufactured home utilities 50.03
Cross street/directions to job site: - (1-:35 Manholes 18.76
L2 2 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: l Lot no.: Fixture or item:
Tax map/parcel no.:
12.51 1 Backflow preventer 1 31.27 1
Backwater valve
DESCRIPTION OF W
44-,4:-'" Clothes washer 25.02
--4l teL'�) 4Dishwasher 25.02
i yi./14,Al(c>4 j Drinking fountain 25.02
Ejectors/sump 25.02
'. d PAQPERTY OWNER I ❑ TE57AN'I' Expansion tank 12.51
Name: ( "' Fixture/sewer cap Vit-- � G� � '�' p 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
APPLICANT ❑ CONTACT PERSON ' Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:
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
y Water heater 37.52
Business name: �rjw j.XA7 V N5�l��
r � "l C( ( � Water piping/DWV 56.29
Address: E�� 1 \ Other: 25.02
City/State/ZIP: , '��Z"1C,46 /9 4._ 2iglq Subtotal
Phone:(77) 75 1 ,-. /S Fax:( ) Minimum permit fee: $72.50
CCB Lic.: es-) -' P1 , .1 1 Lic.no.: Plan review (25%of permit fee)
C/ j State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE S37.26
I
Print name: OAS $ �e 36 f
This permit application expires if a permit is not obtained within 180 days
J /.1,
I / t (, Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/11/09 440-4616T(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-1'100' 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 ValUatlOn: Peru
$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 fust$5,000.00 and$1.52 for
Other Inspections or Fees .` Fee(ea) Total 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(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 for Plumbing Installations ,t
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
Anynew commercial buildingwith water service 2"and
❑
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive as defined in OAR918-780-0040.
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"
3" Isometric or'Riser Diagram
4„
0 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
-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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14031 SW 118TH CT, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2017-00349
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 1 " Wilkins DC ,model 350, serial# A643894 , for irrigation , located behind fence at
right side of house - ok with test
Violation Summary:
Inspector Contractor