Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Permit#: PLM2020-00377
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/24/2020
Parcel: 2S112BD13900
Jurisdiction: Tigard
Site address: 7611 SW CORNUTT ST
Project: Elderberry Ridge, Lot 35 Subdivision: ELDERBERRY RIDGE Lot: 35
Project Description: Irrigation backflow.
Contractor: EASY GREEN IRRIGATION Owner: SATISH, PRABHU EBBADI
1705 CONIFER DR SIDDAVANAHALLI, SHWETHA
LAKE OSWEGO, OR 97034 7611 SW CORNUTT ST
TIGARD, OR 97224
PHONE: 541-420-4790 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/24/2020 $31.27
Specifics: 1 12%State Surcharge- 09/24/2020 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 09/24/2020 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total S81.20
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 NC by g 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: e'7P/42e.
461,17
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. f�
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 ApplicationECEIVED
Building Fixtures
City of Tigard S E P 21 2020 Received ofp. n Permit N
i • 13125 SW Hall Blvd.,Tigard,OR 97223 Dale/By: 7 4, a e, 4X e JpL fi 2 2.0-00 2 l 7
Plan Revie
lilt ® Phone: 503.718.2439 Fax: 503.59s:IsT OF TI G AR D Date/By. Other Permit No.:
-
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: 01/ orris: See Page 2for
Internet: www.tigard-or.gov Nolified/Method✓/ /7Ct A37G'T Supplemental Information
TYPE OF WORK 637 t'i- /4 yt t--- FEE* SCHEDULE
New construction ❑Demolition For special information use checklist.
Description I Qty. . Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
`hY 1-and 2-family g dwellin SFR(2)bath 437.78
❑Commercial/industrial
ElAccessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site Mifflin:
lob site address: '7to I I 5 l.t/LD�II c� S P.'i- Catch basin or area drain 18.76
p Drywell,leach line,or trench drain 18.76
r(1(j City/State/ZIP: ' jC� cF. 97aq
..%% I Footing drain(no.linear R.:_) Page 2
Suite/bldg./apt.no.: J Project name: / Manufactured home utilities 50.03
Cross street/directions to job site: r:Or/7P� 7(p'Z aal Manholes 18.76
C°D,' C4 lit. 4/LI) e-epr/l P✓ l d f 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 I 31.27 31. 27
DESCRIPTION OF WORK Backwater valve 12.51
Syc Clothes washer 25.02
. hS)�/A�/�/ )�/ � t/'4, /e''.- Dishwasher 25.02
(4/f I 1 A 4 CIc-/OC.t) !/i Ge• Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 6hy F44 ,/� Fixture/sewer cap 25.02
Address: 767.�// S r 4C/�`/�/ Floor drain/floor sink/hub 25.02
City/State/ZIP: //90 f�- Q7Z2-C/ Garbagee disposal 25.02
q Hose bib 25.02
Phone:(7�) 300 - V7 3 Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: I / Medical gas(value:$ ) Page 2
4$y ��/ePr� . '//.,4T/Oi 1 Primer 12.51
Contact name: / /11.J yc•-
j Roof drain(commercial) 12.5I
Address: f 70 ) l hTL . _ ,Or. Sink/basin/lavatory 25.02
City/State/ZIP: Lace osutGy v 42 �493 5/ Solar units(potable water) 62.54
Phone:(5 f/) 4-0O - 17 F % Fax: :( ) . Tub/shower/shower pan 12.51
E-mail: e Z ti Urinal 25.02
y C/re's) //'l',�rj'Qt7722i7 ,rn4r-%, ,,/n Water closet 25.02
CONTRACTOR
Business name: ry� � Water heater 37.52
S\ zr/'./4ip`�a'7 Waterpiping/DWV 56.29
Address: 176c /(�I'), n_ ,0/`, Other:
%�r� 25.02
City/State/ZIP: f-1 4- Fax: - 9��3y Subtotal
Phone:(Sy j) U-C 9/.) K( ) Minimum permit fee: $72.50 ?'�, (7
y 7 Plan review (25%of permit fee)
CCB Lic.: L.G.S . Plumbing Lic.no.:
State surcharge(12%of permit fee) 5`,7 C)
Authorized signal fJ 8l, ��
�� TOTAL PERMIT FEE
Print name: 'I /4� f m eye/ Date: 9 '//i� This permit application expires if a permit is not obtained within 180 days
`�7' after It has been accepted as complete.
"Fee methodology set by Tri.County Building Industry Service Board.
I:1Buflding\Pe.mis1PLMU-PmniApp.doc 10/01/09 440-4616T(10l02/COM/WEa)