Permit CITY OF TIGARD PLUMBING PERMIT
L_ t ' COMMUNITY DEVELOPMENT Permit#: PLM2020-00321
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/17/2020
Parcel: 1 S134DA00100
Jurisdiction: Tigard
Site address: 10455 SW NORTH DAKOTA ST
Project: Dakota Station Subdivision: None Lot: None
Project Description: Irrigation backflow.
Contractor: GT LANSCAPING SOLUTIONS Owner: DAKOTA STATION APARTMENTS LLC
2969 FERGUSON ST NW 1025 NW COUCH ST#1415
SALEM, OR 97304 PORTLAND, OR 97209
PHONE: 503-362-7327 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/17/2020 S31.27
Specifics: 1 12%State Surcharge- 08/17/2020 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 08/17/2020 $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 it 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 ques/ttii9+�s to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i-- f^ Permittee Signature: i .
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 Permit An licatio ECEIVED
Building Fixtures FOR OFFICE USE ONLY
Cityof Tigard AUG 0 6 2020 Received
g Date/By: r S f G Penult Not �/j k u7" f10 s Z/
• 13125 SW Hall Blvd.,Tigard,OR 972 Y OF TIGARD Plan Review
0- Phone: 503.718.2439 Fax: 503.5St Other Permit No.:
DateRy
TIGARD Inspection Line: 503.639.4175 ING DIVISION Date Ready/By: ions: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
r.� Description I Qty. I Ea. I Total
YJ Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling Commercial/industrial
SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I 0455 5 W ►J orivi bait to ST. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 'Ii a.rd 012., 9-3..a3„3 Page
Footing drain(no.linear ft.:_) 2
Suite/bidgiapt.no.: 11 Project name:eic-k.t itck stall t jri
Manufactured home utilities 50.03
Cross street/directions to job site: 5V J B4LT.e-al D ST . 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 31.27 9j),gq,
DESCRIPTION OF WORK Backwater valve 12.51
t-c�G-j Cl)-) Clotheswasher 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ErPROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 1 a- e5- -cam U_C', Fixture/sewer cap 25.02
Address: I b 37°I 5w NO(tn > t C D ` - Floor drain/floor sink/hub 25.02
Garbaggee disposal 25.02
City/State/ZIP:--rigGrd 0 C a--a3 Hose bib 25.02
Phone:(605) 55' 8- b (l-+$ Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: -Dayst-e� 5-t- t,Oil Medical gas(value:S_) Page 2
Primer 12.51
Contact name: ps In
Roof drain(commercial) 12.51
Address: \0301 Sy1.5 Nor ba j1-et , ' - 1 Sink/basin/lavatory 25.02
City/State/ZIP: " O('d i 0)2. cr9-"3--3 Solar units(potable water) 62.54
Phone:(So- ) 6 el -O)y$ Fax::( ) Tub/shower/shower pan 12.51
E-mail: CS,_a_C -0.e eoaS--{(In1t Le:0.1 Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: G r ) jS+�ry ry S0)(,�f b►�S
I ''fh ^'. �^ �` L' Water piping/DWV 56.29
Address: 'T4OD Sale-ducts Hwy Other: 25.02
City/State/ZIP: SatQ.m t Die_ q-/-35 I
/ Subtotal 31,9.:9
Phone:(S03 3CQ2 - 9 33. Fax:( ) Minimum permit fee: S72.50 a ,SS:
CCB Lic.: 93 Ce4 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) $I7
Authorized srgg aLr/e�:(®/J� TOTAL PERMIT FEE '�I,tap
Print name)' l � ii� Date:Tier o'?� This permit application expires if a permit is not obtained within 180 days
6 after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01N9 440-4616T(10102/COM/WERI