Permit (159) CITY OF TIGARD PLUMBING PERMIT
. '+ COMMUNITY DEVELOPMENT Permit#: PLM2019-00176
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/29/2019
T[tatl RD 13125 Parcel: 2S109BA05600
Jurisdiction: Tigard
Site address: 13764 SW MISTLETOE DR
Project: Holm Subdivision: HILLSHIRE SUMMIT NO.2 Lot: 42
Project Description: Replacing(1)defective backflow preventer for landscape irrigation.
Contractor: JP STONE CONTRACTORS Owner: HOLM, CARL W&CAROLYN V
400 COLUMBIA ST, SUITE 100 13764 SW MISTLETOE DR
VANCOUVER,WA 98660 TIGARD, OR 97224
PHONE: 503-209-5982 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/29/2019 $31.27
Specifics: 1 12%State Surcharge- 04/29/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/29/2019 $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 may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: J �f� PermitteeSignature: t cr1 �
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. l
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 , 77 FOR OFFICE LSE ONL\'
Received
Cityof Tigard Permit No?
g 7 Date/By: �-4'��11j��\� � t,“"\ ied..(3:\j'cAtk
II III 13125 SW Hall Blvd.,Tigard,OR 97223 ; c; Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960A i '" Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read/B Juris: 0 See Pae 2 for
TIc,,�RI) € . Ready/By: 1 1 g
� Internet: www.tigard-or.gov Notified/Met ..•' \% . it Supplemental Information
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF ccitiS RIJCTIOtSI `
,-;:lo,,,,,-;.,.-!.,-, SFR(1)bath 312.70
® 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
El Master builder El Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE I TION AND LOCATION Site utilities:
Job site address:13764 SW Mistletoe Dr Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Holm Manufactured home utilities 50.03
Cross street/directions to job site:SW Wagoner P1 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
,4„ti Backwater valve 12.51
{y+w �s V �; ill: 1
"` 44 44: •' _ " ''' . " ' Clothes washer 25.02
Replace defective backflow preventer
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
t ` Expansion tank 12.51
Name:Carl&Carolyn Holm Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13764 SW Mistletoe Dr
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
, �r e t .i";, € Interceptor/grease trap 25.02
Business name:JP Stone Contractors,Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:John Stone
Roof drain(commercial) 12.51
Address:8002 NE HWY 99 STE B-623 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98665 Solar units(potable water) 62.54
Phone:(503)209-5982 Fax::( ) Tub/shower/shower pan 12.51
E-mail:info®jpstonecontractors.com Urinal 25.02
;u
,,. r Water closet 25.02
+b' :.mow.'." ,e . ; a v:.'." Water heater 37.52
Business name:JP Stone Contractors,Inc. Water piping/DWV 56.29
Address:8002 NE HWY 99 STE B-623 Other: 25.02
City/State/ZIP:Vancouver,WA 98665 Subtotal 31.27
Phone:(503)209-5982 Fax:( ) Minimum permit fee: $72.50 72.50
CCB Lic.:LCB:8549 51 `t1�=-t Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: \ TOTAL PERMIT FEE
Print name:John P.Stone Date:04/26/2019 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)
J 4
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
alteXtIlitItsQtyFee(ea) Total :.. 're �'ee Permit Fee`
ka.
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 -- t
Valuation: Permit 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
Othe1C InS Or QtY fec f4sJ 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*.
Qua Fixture Type RW *11
-.. 6 ° ....ny
, „ , m ,iutpee Type for , ._.,.._....
Plan review is required for anyof the following.
Workrerfbrmped: Capped Added Relocate, 9
Baptistry/Font Please check all that apply.
0 Any new commercial building with water service 2"and
Bath -Tub/Shower
greater,except systems designed and stamped by
licensed
-Jacuzzi/Whirlpool
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the •ualifications 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:\Users\JP Stone Contractors\Documents\PLMF_PermitApp-Holm.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13764 SW MISTLETOE DR, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2019-00176
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 1 " Febco DC model 850U, serial # H19070, for irrigation,located at left corner of
sidewalk and driveway, to replace existing device serial # A028762 - Approved with test
Violation Summary:
Inspector Contractor