Permit (113) CITY OF TIGARD PLUMBING PERMIT
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Permit#: PLM2018-00379
`��� SI ` COMMUNITY DEVELOPMENT
111
Date Issued: 10/04/2018
T f.0Afg D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S111AA12400
Jurisdiction: Tigard
Site address: 8852 SW INEZ ST
Project: Butterfield Park,Lot 11 Subdivision: IRMA DELL BUTTERFIELD PARK Lot: 2
Project Description: Backflow preventer for landscape irrigation.
Contractor: AUSTIN BROWN LANDSCAPE Owner: FOUR D CONSTRUCTION
PO BOX 14441 P.O. BOX 1577
PORTLAND, OR 97293 BEAVERTON, OR 97075
PHONE: 503-887-7795 PHONE: 503-720-7445
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/04/2018 $31.27
Specifics: 1 12%State Surcharge- 10/04/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 10/04/2018 $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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/,,e/. ...___
Issued By: &r.te.. .........
-•rmittee Signature: /rrr/// c
Call 503.639.4175 by 7:00 a.m.for the next available inspection d te.
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 FixturesL'''' FOR OFFICE SF. ONLY
." ' I_
City of Tigard Received A/
Peril'. 4Z/fr402_0(Pr/032 5
iu 13125 SW Hall Blvd.,Tigard,OR 9720 1r, ( 2.018
I Phone: 503.718.2439 Fax: 503.5986W
1111 Date/By: _./;,7,/ ! fiAir
Plan Review
Date/By:
Other Permi9t,es77,00-Cb V-4,70-
Inspection Line: 503.639.4175
TIGARD ) Date Ready/By: Juris: Ed See Page 2 for
Internet: www.tigard-or.gov
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Supplemental Information
----- „..,..,;,N „ FEE* SCHEDULE
W-- c•-•T4'''''''' '''' a ' ' ''
For special information use checklist.
11451w construction El Demolition
Description Qty. Ea. Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CA'AGORY OF co14sTrt •.''4WIC.- SFR(1)bath 312.70
.1r•-•0 and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
El Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
jCI FORIVLiTIONI;A:114 ii6N , , Site utilities:
IIAITE IN 4."'" Catch basin or area drain 18.76
Job site address: s 5.v.) 1 tJ1?-"?-
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -1"ic1 (4-?e49 / enf___ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 27,,,k.1rt,O't-F1 -1..19 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.: k k Fixture or item:
Backflow preventer 31.27 (
Tax map/parcel no.:
12.51
D'isc' ' 4"-)N*#ot,:f '-'*-44: ' -'''' ''''''' :,' Backwater valve
Clothes washer 25.02
6 A-c-ILn-mi) yote2-Fue,k)1rtyrt Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,,4 , ,-,,,,,,, '''S '-'''''' Expansion tank
RD 6:rta74,, OWNER ,-4„,,,,: j- g' ''' 'Li ' h4e.,....,,,, . 12.51
- ST
Name: CP --i l,i,_- Fixture/sewer cap 25.02
F-51A t-- \AO C ' ) (21 1/(C ( v"•3
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
- ,,," ...,rrzkppuc*; ,`:•R7' , , -,:-.'--* i?,.k ACT,PERSQ .'"- Interceptor/grease trap 25.02
, n Medical gas(value:$ ) Page 2
Business name: rekNIVII.1 K.) 4; (2...41AAJA.3 GIA-4010g-4W ili'1/41*-.-,
Primer 12.51
Contact name: 4or , *., i32...iviv1/4.1 Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(crc5) SKI,' 7_ 2-- -16- Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
e4isiTRA0iii
heater 37.52
Business name: ifkui 5-7 ,eL) 6 redidu)kJ kA-posc,,,a-rik. piping/DWV 56.29
Address: 196 f7c7c ((Pig i Other: 25.02
City/State/ZIP: fty1,1 uvrt- 0 (fl - 11 .,..)-47, Subtotal
Phone:(g5-5) -('''‘4- I-1-i( a _ Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: 501,..%0
,.., -..r.,. ...g Lic.no.:
.4,7 ,.
State surcharge(12%of permit fee)
Authorized signature: ..4V‘ TOTAL PERMIT FEE 2-7„,26
Print name: Aticfi ' "IF Date: " / (...6 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.
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:
Si.t„ ti it1eS.,# Qty. Fee(ea) {Total SqU =FQ a K' Pernl tee: #.
Footing drain-1s`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 Valuatio1l.
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
i ' a Qt3, t Fee(ea) Total each additional$100.00 or fraction thereof,to
Ot tear Iri io`o „ r ee .:t* lF 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*. 17- I "> c for pi .e 1 mg nsta lations
Quantity by Fixture Type : Plan review is required for any of the following.
Fixturee' ' ` Replace/ Please check all that apply.
�`p�for �n pp Y•
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/Whiripool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Aspirator 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water
Dishwasher:: -Commercialirator ❑ 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"
'_ 1inlne t r,R3r.plag. :l
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
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 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:
8852 SW INEZ ST, TIGARD, OR, 97224 November 1 , 2018 at
10:09:19 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00379
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Wilkins irrigation backflow device model 350 ser#A723380 located right side of
structure approved with test report.
Violation Summary:
Inspector Contractor