Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018 00100
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/13/2018
Parcel: 2S 111 AA11600
Jurisdiction: Tigard
Site address: 14412 SW 90TH AVE
Project: Greensward South,Lot 10 Subdivision: GREENSWARD SOUTH Lot: 10
Project Description: Backflow preventer for irrigation.
Contractor: AUSTIN BROWN LANDSCAPE Owner: FOUR D CONSTRUCTION
PO BOX 14441 PO BOX 1577
PORTLAND, OR 97293 BEAVERTON, OR 97075
PHONE: 503-887-7795 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/13/2018 $31.27
Specifics: 1 12%State Surcharge- 03/13/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 03/13/2018 $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 ma: obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 o . 2.2344.
Issued By; Permittee Signature:
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_...riviAlArAPPA...- ..- _ ..
Call 503.639.4175 by 7:00 a.m.for the next available inspection date f /f
This permit card shall be kept in a conspicuous place on the job site until comple on of e project.
Approved plans are required on the job site at the time of each inspectio
Plumbing Permit Application
Building Fixtures prp FOR OFFICE USE ONLI'
City of Tigard / ® ReceivedVED BJ/ ,? _ Permit No.: D C V j
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: i 6 r
g Plan Review ,
c Phone: 503.718.2439 Fax: 503.598.196 Other Permit No.: /� r }
9�AR 1 � 201 Date/By: !•1�1 �I 7`(r�:r
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: l0 See Page 2 for
Internet: www.tigard-or.gov tt-yY tit r i D Notified Method: 7:,,..0 Supplemental Information
TYPE OF:W I.: i IL DIVISION FEE* SCHEDULE
pew construction El Demolition For special information use checklist
Description Qty. Ea. 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
V4:4-
and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
O Accessory building ❑Multi-family
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 k)( 1) S\i`..1 I OA, Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: V e ( Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:
J N Manufactured home utilities 50.03
Cross street/directions to job site: i V -t• - 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer l 31.27 J }'7
Tu �'' . Backwater valve 12.51
DES, ,ION De„‘WORK '>
Clothes washer 25.02
(7 K..f 61-=, i 1•-1 5 ilA'ZK C- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
RR" IERTYO tt R fl TENAI 1 Expansion tank 12.51
,, , r .; y
Fixture/sewer cap 25.02
Name: �� 9
(�% �lti� 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 _ 41 ,. TTACT PERSON :"1'.4%; 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 6
:; _, ,;t, : - i Water heater 37.52
Business name: 1 c7/jJ ( 1Ziilu'ti t A')cc fk-V11kC Water piping/DWV 56.29
Address: j �- (,.- 1'1( Other: 25.02
City/State/ZIP: f°c'�i.1(..,v\--0.4 1 O N Gf-7'?�f Subtotal .3 ,)..-7
Phone:((L ) '7- ) Fax:( ) Minimum permit fee: $72.50 -U
Plan review (25%of permit fee)
CCB Lic.: ,4 P i mg 'r.no.: State surcharge(12%of permit fee) 7
Authorized signature: ® TOTAL PERMIT FEE'i , t
iM
f((�-) � ' J Date: J r 7( This permit application expires if a permit is not obtained within 180 days
Print name: ) / after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Se ice Boardd.. I. l
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) /C2• /C (6' ;)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities; Qty. Pee(ea) x T iii Siluare Foota .` Permit Fee:
Footing drain-1S1 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' 37.52VaIuation: Permdt
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
To ,; each additional$100.00 or fraction thereof,to
Other Inspections Or Feels ("y, Fee(ea) y �. 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$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accuratelyreportfixtures
could result in increased sewer fees*.
SW-Review for Plumb* #allahons .$
Q>tantity ilyixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: 'Capped Added Relocate
Baptistry/Font 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall 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 ❑ 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 Piairam,
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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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