Permit (199) CITY OF TIGARD PLUMBING PERMIT
.. COMMUNITY DEVELOPMENT
p Permit#: PLM2019 00318
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/07/2019
Parcel: 2S 110 D D02200
Jurisdiction: Tigard
Site address: 10535 SW CENTURY OAK DR
Project: Redman Subdivision: SUMMERFIELD Lot: 29
Project Description: Backflow preventer for irrigation.
Contractor: WINTERBLOOM INC Owner: REDMAN, CATHY S
14780 SW 98TH AVE PO BOX 716
TIGARD, OR 97224 NEWBERG, OR 97132
PHONE: 503-598-0219 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/07/2019 $31.27
Specifics: 1 12%State Surcharge- 08/07/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/07/2019 $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: Orego law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 t roug •AR 952-001-04'II You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
4OP- -
Issued By: /� •ermittee Si Pr
9 r.01
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Call 503.639.4175 by 7:00 a.m.for the next available i 'pection 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 ECEIVl'Ok OFhiCI. I'SE O\l.l
City of Tigard Received
ate/By: 7//'( Permit No.: , g 111 S 3 ,„
III
n Review
3
111111
13125 SW Hall Blvd.,Tigard,OR 97223 7 211 ` l 6
= Phone: 503.718.2439 Fax: 503.598.1960 AUGtJ
Date/By: Other Permit No.: rY1 -y 'Kali'7
1.1�, It D Inspection Line: 503.639.4175 ! (7 u
Internet: www.tigard-or.gov CITY OF TIG'' 'nu.Ready/By: Juris: ® See Page 2 for
LQ NG Div RO d/Method Supplemental Information
iiipt* * ,- ,- --. '. 1 wK ---:---, - z ----- .>` ":'''',11"'•
:1:M11"6:
❑New construction 0 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 R.for each utility connection)
_ CATEGORY tOF CONSTRUC!"CON SFR(1)bath 312.70
/'--' 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
I:3 Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOcATIQN Site utilities:
Job site address: /��,? cr j� 0!( Catch basin or area drain 18.76
// Dtywell,leach line,or trench drain 18.76
City/State/ZIP: "`
< y / 97 � Footing drain(no.linear ft.: ) Page 2
L C�i
Suite/bldg./apt.no.: d Project name: 1, kan Manufactured home utilities 50.03
Cross stre t/directions to job site: 7 Manholes 18.76
elt,'44 /,'t 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 31.27
/
"vx$ a r ..,-,,,,,:i.,''stn. AL.-- :`: ; „ ; Backwater valve 12.51
Clothes washer 25.02
/.HJ/ j �Cy �' p �'�ir
Dishwasher 25.02
7 7yq ' (f'd -�!i �_ Drinking fountain 25.02
Ejectors/sump 25.02
'. , I, �i ,, � ,. g ., A Expansion tank 12.51
Name: �'k'iy /,/ �C0L-t Fixture/sewer cap 25.02
Address: G U 5-�c/- / u$0.7/ d�� /,Ti Floor drain floor sink/hub 25.02
City/State/ZIP: y,,,,,,,,./
C �� Garbage disposal 25.02
_ Hose bib 25.02
Phone:(9 ;I/� / - Fax ( ) Ice maker1,,,�., ! 12.51
m'; _ "' 4.'« 51; f h Interceptor/grease trap 25.02
Business name: F. ,,,,,,,,-- �f� /i,�; Medical gas(value:$ ) Page 2
Contact name: Gi( e 7 l/�'/ Primer 12.51
Address: jam, Blit
Roof drain(commercial) 12.51
�' `V Sink/basin/lavatory 25.02
City/State/ZIP: it -/ c l 2, '"
Solar units(potable water)
_ - /lir M'� �_ 62.54
Plmne O pan
-/ ax::( ) Tub/shower/shower p 12.51
E-mail: L Urinal
..e,--7/..-:
dock
jA e„,,/,„7/40,,,,,,_ .5 � .I l/�ifif 25.02
I I Water closet 25.02
. ..,.0 "_ s-,„ * "e" .'fi, '.--- "-' ., . � fir,
r-- Water heater 37.52
Business name: I-S�'��d?'1 e a.J , ���
Water piping/DWV 56.29
Address:
Other: 25.02
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone:( ) Fax:( )
( 3 CCB Lic.: ammo" Ply 'Lic.no.: " '? Plan review (25%of permit fee)
�
f State surcharge(12%of permit fee)
Authorized signatur: f. _,''
TOTAL PERMIT FEE
Print name: `i.4 Date: E5/27, / This permit application expires if a permit is not obtained within 180 days
G 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:
nr
qty: Fee(ea) Total
e e� _ Square footage:` Permit Fie: ._. _
Footing drain-l't 100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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: 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
Total _ each additional$100.00 or fraction thereof,to
Other ill$pecflons or a 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 90.00/1u $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to 5_
accurately report fixtures could result in increased sewer fees*. afl Re .* or u . %, "Ins 4 s �` ``'
m
,Atualitiq by Fixture Type Plan review is required for any of the following.
FixtureType for leptece Please check all that apply.
Work
Performed: CIIPPed , Added,-: Retocate 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/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
r=
Floor Drain sink: 2" try t ` E s ei D a .
0 Isometric or riser diagram is required for new b
- - - uildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2