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Permit CITY OF TIGARD PLUMBING PERMIT ■. COMMUNITY DEVELOPMENT Permit#: PLM2020-00205 Date Issued: 05/21/2020 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135BC00700 Jurisdiction: Tigard Site address: 10795 SW CASCADE AVE Project: Wiggle Land Subdivision: None Lot: None Project Description: Replacing backflow preventer. Contractor: LOVETT INC Owner: CASCADE FUTSAL LLC PO BOX 86280 5010 NE OREGON ST PORTLAND, OR 97286 PORTLAND, OR 97213 PHONE: 503-737-8423 PHONE: FAX: 503-288-1630 FEES Quantity Description Date Amount 1 ea Backflow Preventer 05/20/2020 $31.27 Specifics: 1 12%State Surcharge- 05/20/2020 $8.70 Plumbing Type of Use: COM 41 ea Minimum Fee Adjustment- 05/20/2020 $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 32.1987 or 1.810.332.2344. Issued By: /'gar/ Permittee Signature: 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. RE Plumbing Permit Application E� f�,/� © S/ . Site Utilities MAY 6 2020 ,:olz Orf if t: Si.n ONLY City of Tigard CITY OF TIGARI3 Re Ya s- f� J 't/. 13125 SW Hall Blvd.,Tigard,0R c �° �Q�� C Phone: 503.7183439 PBX: SD3,18 9DIING DRA`'It 1y'lanReview 1 f/- I WART) Inspection Lino $03 639 4175 Dote/By: i e �`'��'] �� Internet www.tigard-or.gov Date Ready/led/MoBy muse 0 See 2 for ,.xc- Notified/Method: Supplemental Information k r r r,-.>i . �_i ..-„ 1,'YP$«O?' r ''y ? a. t i 0 New constnrction a °" ' ❑Demolition For special information use checklist n3 i Addition/alteration/replacementDescription I Qty. Ea. k 0 Other: Total �� � .� 3� ,� � New I-Z-fflmily dwellings(includes 100 ft,for each utility connection) d i t � �fS'' . PF, ao 6_.x . ..: .x ,,Wa:Mi i ( )bath 312.70 �,,.*.__. � ���Q�,.' `'�� � SFR i ❑ 1-and 2-family dwelling (R Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builder r Each additional badJkitchen 25.02 ❑Othe t a �.y ay , ,� ;�y X N Fire sprinkler( sq.it.) Page 2 , .. wJS�R '1` );()VR1Y/A 'I(��I I JL�L,,Q ''r5 -,*?'" .., i� i Site utilities Job site address: ,t--1qr am eb Cam Catch basin or area drain 18.76 City/State/ZIP: '9 `A�a a cri 2 Drywall,leach line,or trench drain 18.76 Suite/bldgJapt.no.: ( Project name:W` Footing drain(no.linear ft.:_) P 22.3 ' �r cl Manufactured home utilities 50.03 1. Cross street/directions to job site: aA) 12,02n .9 g A, Manholes 18.76 Rain drain connector 18.76 ti Sanitary sewer(no.linear ft.: ) Page 2 it Stonn sewer(no.linear ft.: ) Page 2 6 Water service(no.linear It.: i Subdivision: + ) Page 2 I no.: Fixture or item: k Tax ma plparcel no Backflow preventer 1 31.271. ,VI,,a"€w fg. V DESCRIPTION OiNi? ,icilr,"u:;aisry. ` �,r*t`' r';.'"* Backwater valve 12.51 10RA. IOPG�Lk\OW (AAA 1 - Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 >' , EJ PROP li `Y OWJN'RR r r .6 t �,ym, z 3 ".._ .,_ �' . .= � _.=�t;a "i'Q„ .!��?°;,it �.i:1 u t% Expensiontank 1251 Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 City/State/ZIP: Garbage disposal 25.02 rr Hose bib 25.02 Phone:( ) f Fax:( ) rly{�� �.O``�,, Ice maker 12.51 VA�.,, .. inlcrceptor/greesetraA 25.02 Business name: �� i nr Medical gas(value:$_) Page 2 I Contact name: (�ar A. Primer 12.51 Al;t ,a ` Address: /I r Roof drain(commercial) 12.51 I.p?�0 `,, 6 4�' Sink/basin/lavatory 25.02 City/State/ZIP: CY(k ogq. 0g r z r p Solar units(potable water) 62.54 Phone:(t) 611E K. YFax::(` ) Tub/shower/shower pan 12.51 E mail Urinal { yleiN\ S@ 14Yt 6;45.con zs.oz I O)TI IiACTDR . Water closet 25.02 M"` '"'' Water heater Business name: Lev1. int. 37.52 Water piping/DW V 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: S72.50 CCB Lic.: 1 5F1 a Plumbing Lic.no.: �I p Plan review (25%of permit fee) t `{t--11?5�$� State surcharge(12%of Authorized signature: N^„ plot pMITtfeE ()v�y�. Y ( TOTAL PERMIT PEE Print name: H^ {� Z I � V'20i0 Thispermite p�1 11'��A 6 a Date: ( application expires if a permit is not obtained within 280 days after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. t:laik6oglPttmaslPLINtl. eonilApp.doe 10/01/09 4404616T(I0/02/COMhwEa) I i