Permit (155) CITY OF TIGARD PLUMBING PERMIT
2..
COMMUNITY DEVELOPMENT Permit#: PLM2018-00341
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/11/2018
T[CA Parcel: 1S135BD02000
Jurisdiction: Tigard
Site address: 9590 SW ANNA BELLE CT
Project: Ash Creek Village,Lot 6 Subdivision: ASH CREEK VILLAGE Lot: 6
Project Description: Backflow preventer for irrigation.
Contractor: TRUSCAPES Owner: SAGE BUILT HOMES LLC
21600 NW AMBERWOOD DR 1815 NW 169TH PL STE 1040
HILLSBORO, OR 97124 BEAVERTON, OR 97006
PHONE: 503-707-0213
PHONE: 971-221-4597
FAX: 503-352-4607
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/11/2018 $31.27
Specifics: 1 12%State Surcharge- 07/11/2018 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 07/11/2018 $41.23
Type of Use: SF 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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.3 - .
Issued By: •ermittee Signature:
L. _
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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 FOR OFFICE USE ONLY
City of Tigard Received `'� //
-t`I lute/By: / // I `�' Permit No.:,44,13.2i 603, /
II IIIII13125 SW Hall Blvd.,Tigard,OR 97223 ‘.:77,._ l
Phone: 503.718.2439 Fax: 503.598.1960Plan Review
_ ' Date/By: Other Permit No. �2,,1i �y/l�
Inspection Line: 503.639.4175i4C, ".., Date Read/B Jury: See Page 2 for (/L C^'�
TICARD �o Ready/By: B
Internet: www.tigard-or.gov + +t 1Q ONotified/Method: ry SupplementalInformation
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TYPE OF WORKV- FEE* S HEDILE
❑New construction 0 Demoliti 1 c--
,',,,', ° -,-"q:-.,,r,,' For special information use checklist
,\--)1,\,!'- Description Qty. Ea. Total
E Addition/alteration/replacement then. 'lq"
p � � New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONS-yucTIO''''N SFR(1)bath 312.70
El1-and 2-family dwelling 111Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
4.; JOB.SITE (FORMATION AND LOCATION " ' Site utilities:
Job site address: `/`)C(0 •3 tr: �y� i �^ Catch basin or area drain 18.76
' ` `, l Drywell,leach line,or trench drain 18.76
City/State/ZIP: ,
(1 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: �vL �i SCJ 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
Water service(no.linear ft.:_) Page 2
Subdivision:4`31/.\ CW, Ic 1 Lot no.: G _Fixture or item:
Tax map/parcel no.: Backflow preventer I 31.27 7j1,Z1
; "„, Backwater valve 12.51
- ,. ;, ,7 a{; CRIPTION'OF?PORK
T Clothes washer 25.02
3 �C ��1\ if '�J.� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
x4 4
OPERTX OWNER TENANT u _Expansion tank 12.51
Name: 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
s ❑ Ti APPLICANNTACT N Interceptor/grease trap 25.02
Businame:JGi Cir Bl\,1‘\- k..�,, s Medical gas(value:$ ) Page 2
ness
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: j�
1 pi 0,,c Sink/basin/lavatory 25.02
City/State/ZIP: 2 6 A R '(1, Solar units(potable water) 62.54
Phone: C ') Fax:: Tub/shower/shower pan 12.51
E-mail: ,e �,t p ��\`� coin Urinal 25.02
, ,,. . Water closet 25.02
14 r CTUR ��.
Water heater 37.52
Business name: 111nSGCk - Water piping/DWV 56.29
Address: , 1 ��`� �, �, Other: 25.02
-
City/State/ZIP: l`i)// a_ q -7 icy/ _ Subtotal 3i. 2-7
F- / Minimum permit fee: $72.50 7,Z-$7)
Phone:(5-(-)3) --70-7 _C.)vtl 3 Fax:( ) Plan review (25%of permit fee)
CCB Lic.: '? (aPlumbing Lic.no.:
c - - State surcharge(12%of permit fee) r....Plumbing
Authorized signature: 1 • ,� y� � TOTAL PERMIT FEthi�'i, }Z)
This permit application expires if a permit is not obtained n 180 days
Print name: �, ,♦ Date: - l _ 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:
ki
tilitie L i e tea) Voil Square Footage Pei*Footing drain-Pt 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
Valuation: Per
t 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
Qty. Fee(ea) Total# each additional$100.00 or fraction thereof,to
Other Inspecti►> s or Feesand 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*. _ 'lan Review for Mum g °° allati00 ,Rr
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
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 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"
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 MachlRefrig.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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9590 SW ANNA BELLE CT, TIGARD, OR, 97223 July 24, 2018 at 10:47:45 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00341
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
1 " febco model 850, serial number 59050 located under entry stairs.
Violation Summary:
Inspector Contractor