Permit (173) CITY OF TIGARD PLUMBING PERMIT
1111
COMMUNITY DEVELOPMENTPermit#:
PLM2018-00366
1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/09/2018
Parcel: 1 S135BD01300
Jurisdiction: Tigard
Site address: 10830 SW GREENBURG RD
Project: Washington Square Inn Subdivision: None Lot: None
Project Description: The improperly installed 1.5"RP backflow prevention device for irrigation system is being replaced with a 1.5"
double check backflow prevention device that is installed to code.
Contractor: HOLMES IRRIGATION & BACKFLOW Owner: SCHAEFER, ROBERT M&SALLY J&
PO BOX 86 MILLER, GERALD V
HUBBARD, OR 97032 BY SHILO INN-WASHINGTON SQUARE
11600 SW SHILO LN
PORTLAND, OR 97225
PHONE: 971-275-4306 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/09/2018 $31.27
Specifics: 1 12%State Surcharge- 08/09/2018 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 08/09/2018 $41.23
Class of Work: ALT 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / 4 Permittee Signature:
e+770"/
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 PermitApplicatio E .
Building Fixtures l O R 01 i R I;i S I ()NIA
City of Tigard ,j U L. 2 5 2018 Received /
Date/By: 7 L- J/e Permit No
II 1 13125 SW Hall Blvd.,Tigard,OR 97223 �r P� �������"
Phone; 503,718.2439 Fax: 503.59 TIGARD
Review
T �y F�3A� Date/By. Other Permit No.:
Inspection Line: 503.639.4175rr< nl t 7 g� T
$ g a 1,111 i.���d �O Re ylBy: lura &(See Page 2 for
Internet www tt dor Ov t ..ified/Method:7jZ� /� ,Supplemental Information
�. :. '#A.,•;',.. : .a„ ..�, , '.:,.. ., �*.,4,. .'++ `s` if'y. � .d „ as v M /"A� F.,� ,'� n,�., 5�,,i,9 0 5s scrag'
0 New construction 0 Demolition For special information use checklist.
®Addition/alteration/replacement 0 Other: - Description 1 Qty. I Ea. I Total
A;� Vi New 1-2-family dwellings(includes 100 ft.for each utility connection)
� . ",A ..,,,, Ii C- .,`�. a.;--r;..,, N ,,,. �. .fa (1)bath
, :it SFR312.70
❑1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family s (3)bath 50032
❑Master builderEach additional bath/kitchen 25.02
0 Other 41
z- x "" n sa a. s a� r.. Fire sprinkler ft.) Page 2
:; .. �. ��..e .. �:N,. i “ ' Q$ ; ',.. m ... ; Site utilities:
Job site address:10830 SW Greenburg Rd Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:__) Page 2
Suite/bldg./apt.no.: I Project name:Washington Square Inn 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Ya Backwater valve
12.51: ` 3S ^+ ) . °fro
«x i g.. _:4.;�-, a:a
Clothes washer 25.02
The improperly installed 1.5"RP backflow prevention device for irrigation
Dishwasher 25.02
system is being replaced with a 1.5"Double Check backflow prevention device Drinking fountain 25.02
that Is installed to code. Ejectors/sump 25.02
PRb d tEansion tank 1251i °4rii Q- :Jv, z . p
Name:BHGAH SQ WA LLC Fixture sewer cap 25.02
Address:8840 Holly St Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Wilsonville,OR 97070 Hose bib 25.02
Phone:(503)783-5222 Fax:( ) Ice maker 12.51
N. i .ria" w., w ` °. 43ç $ A� ,. Intersetor/8rease trap 25.02
Business name:Holmes Irrigation&Backflow Medical gas(value:$ ) Page 2
Contact name:Nathan Holmes Primer 12.51
Roof drain(commercial) 12.51
Address:2737 B St Sink/basin/lavatory 25.02
City/State/ZIP:Hubbard,OR 97032 Solar units(potable water) 62.54
Phone:(971)2754306 Fax::( ) Tub/shower/shower pan 12.51
E-mail:HOLMESIRRIGATIONI7@GMAIL.COM Urinal 25.02
6R aad of n'1 s Water closet 25.02
Water heater 37.52
Business name:Holmes Irrigation&Backflow
Water piping/DW V 56.29
Address:2737 B St. Other: 25.02
City/State/ZIP:Hubbard,OR 97032 Subtotal „3.I.2T
Phone:(971)275-4306 Fax:( ) Minimum permit fee: $72.50 72.50
CCB Lic.:9531 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8.70
Authorized signature: "l • fY TOTAL PERMIT FEE ,�1!12'r7
Print name:Nathan I Holmes Date:7/23/18 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete. ,f f ,Z 0
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PenntApp.doc 10/01/09 440-4616T(ION2JCOM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
A �. 0A3, ,ate' : i 9 .t t
Footing drain-1u 100' y_ 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 S stems:
Water Service each additional 100' 37.52 0 ®
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
3r 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 $37930 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*.
Quantify by Plxture'rPe " tK'' lir a-""at , 1±±5 t' 1 ° 'talk**.
Z'yP foroce
Fixture
V ki'eriornietL Capped u` Added; locate: Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in DAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3„
Car Wash Drain _. ,_ .r.. ..
Garbage Domestic-non-fooa
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:1Userslnholm_000\Downloads\PLMF PermitApp.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10830 SW GREENBURG RD, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00366
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 1 1/2" Febco DC model 850, serial # 38156,for irrigation, located at right side of
driveway entry by light pole to replace existing RP device that was installed incorrectly-
approved with test.
Violation Summary:
Inspector Contractor