Permit CITY OF TIGARD PLUMBING PERMIT
'F4 II
• COMMUNITY DEVELOPMENT Permit#: PLM2020-00346
Date Issued: 9/21/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 112 BD 13700
Jurisdiction: Tigard
Site address: 14797 SW 76TH AVE
Project: Schaffer Subdivision: ELDERBERRY RIDGE Lot: 33
Project Description: Irrigation backflow.
Contractor: OWNER Owner: SCHAFFER, CHRISTOPHER
14797 SW 76TH AVE
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/21/2020 $31.27
Specifics: 1 12%State Surcharge- 09/21/2020 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 09/21/2020 $41.23
Type of Use: SF
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.
Issued By: PermitteeSignature:
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 Application
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Building Fixtures IP V- C g ' P -t.) FOR OFFICE USE ONLY
City SW
Received
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13125 SW Hall Blvd.,Tigard,OR 97223 U 2 5 2�2� Plan Revie
Phone: 503.7I8.2439 Fax: 503.598.196d Other Permit No.:
Date/By:
Inspection line: 503.639.4175
TI GARD Dalz Ready,By: Jam El See Paget for
Internet: www,tigard-or.gov NotifiedMlethod- Supplemental Information
TYPE OF Ncoalc -:1t .V1 ° FEE* SCHFIULF
❑New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total _
(g)Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
N 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family 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:14797 SW 76th Ave 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.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Located between SW Cornutt St and SW Hansen Ln 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: Elderberry Ridge Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer X 31.27
DESCRIPTION OF WORK. Backwater valve 12.51
Clothes washer 25.02
Installation of backflow preventer for landscape irrigation Dishwasher 25.02
system Drinking fountain 25.02
Ejectors/sump 25.02
X PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Christopher Schaffer Fixture/sewer cap 25.02
Address:
14797 SW 76th Ave Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Tigard / OR / 97224 Hose bib 25.02
Phone:775 ) 622-5742 Fax:( ) Ice maker 12.51
X APPLICANT ❑ CONTACT PERSON' Interceptor/grease trap 25.02
Business name: Owner Medical gas(value:$_) Page 2
Primer 12.51
Contact name: Christopher Schaffer
Roof drain(commercial) 12.51
Address: 14797 SW 76th Ave Sink/basin/lavatory 25.02
City/State/ZIP: Tigard / OR / 97224 Solar units(potable water) 62.54
Phone:(775) 622-5742 {Fax: :( ) Tub/shower/shower pan 12.51
E-mail: c h r I S 11 1 kQu�- c ha fFe tre) �Gl� t r Al- Urinal 25.02
f CONTRACT-OR
1 Water closet 25.02
' I Water heater 37.52
Business name: , -le Jam- Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7Z.f0
Plan review (25%of permit fee)
CCB Lie.: Plumbing Lic.no.: State surcharge(12%of permit fee) d't '7a
Authorized signature: J / TOTAL PERMIT FEE �/r 2a
Print name: //j/ ,/'/„ Date: 8-25-20 This permit application expires if a permit is not obtained within 180 days
L _� after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMO-PermitApp.doc 10/01/09 440-4616T(10/02ICOM/WEB)