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Permit CITY OF TIGARD PLUMBING PERMIT '1 ,` COMMUNITY DEVELOPMENT Permit#: PLM2020-00394 Date Issued: 10/8/2020 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S114BB08900 Jurisdiction: Tigard Site address: 16264 SW 104TH AVE Project: LANGE Subdivision: SWANSON'S GLEN Lot: 30 Project Description: Backflow preventer for irrigation. Contractor: OWNER Owner: LANGE, NIXON GRAY& HILLARY LYNN 16264 SW 104TH AVE TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 10/05/2020 $31.27 Specifics: 1 12%State Surcharge- 10/05/2020 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 10/05/2020 $41.23 Plumbing Class of Work: OTR Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC(� by calling 503.232.1987 or 1.800.332.2344. Issued By: t �1 J �• /�� Permittee Signature: C'I' �(t�A1 C.0 .� �^ fl �1 t1 10 ( \ Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application t V E ID 4le 'Zp - e Building Fixtures 2020 Cityof Tigard Receives P> ._ Permit No.: III • 13125 SW Hall Blvd.,Tigard,OR 97223 „ Date/By: IG f�Ig-p �` p4/1/���yj-ay�/ "I Plan Review 3"" v Phone: 503.7182439 Fax: SD3.598.19(i0 t �`t! ;;`,i DateMy: r'i/,/� Other Permit No.: Inspection Line: 503.639.4175 i I�.A I:LI Date Ready/By: I J . ® See Pagel for Internet www.tigard-or.gov Notificd/Method. /0 / r/b ', ^ t( Supplemental information TYPE OF WORK , FEEFEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. Description I Qtv. I Ea. I Total ($Addition/alteration/replacement 0 Other: New 1-2-faaafy dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 g 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ElAccessory building CI Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fite sprinkler( ,sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION ' Site utilities: Job site address: 1 W rtio 9 S W (b t{4(n RUB Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: 1 C,-.1 OR- 91 Z2- l / � _ t Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name: LA.0f�E =T �R1�t[r'C1o�{ Manufactured home utilities 50.03 Cross street/directions to job site: 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: Lot no.: Fixture or item: Tax map/parcel no.: Backflow prevetiter I 31.27 ),`1:1 DESCRIPTION O_ F_WORK _ Batkwattrvalve 12.51 tC-1-4-to-) Plothes washer 25.02 �Cr� ��; � r"� Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 E:1 PROPERTY OWNER 0.TENANT Expansion tank 12.51 t,\XQn ` ��t Fixture/sewer cap 25.02 Name: t, W f� Floor drain/floor sink/hub 25.02 Address: I fp-U12G( S� 1Olf+k A V- Garbage disposal 25.02 City/State/ZIP: '1 a_r'cl I 62 1'1 2.2`f Hose bib 25.02 Phone:(111 b) 3'2 - I f o Fax:( ) Ice maker 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: - Medical gas(value:$_) Page 2 Primer 12.51 Contact name: ---- Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/StateJZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail:A/9 16 r1 e 3 cJ< ("-1 Urinal 25.02 J 1 t Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: V w„/"1�` Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal $ ,'71 Phone:( ) Fax:( ) Minimum perrnit fee: 572.50 1Z,S0 CCB Lie.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) $,"f 0 Authorized signature: p TOI7 � �'Z Print ttanu. Li' ,. Date:1-D-2 0This permit application expires if a permkTAL Is norPERM obtainedFEE within Ia0)dapp after it hod been accepted a complete. 2,4 *Fee methodology set by Tri-County Building Industry Service Board. 1:lauad ag\PemiltstPlMU-Perm6App.doc 10/01/05 44e-4616TI 10102/COM/WEB) • _.. Branden Taggart From: Branden Taggart Sent: Thursday, October 1, 2020 9:36 AM To: 'nglange3@gmail.com' Subject: Plumbing Permit: PLM2020-00394 - 16264 SW 104th Ave. Attachments: Invoice.pdf Hello Nixon, The Plumbing permit for a backflow preventer is ready to issue now. The balance due is$81.20, and I have attached an invoice above for you to reference. The permit fees can be paid online through our website: https://aca.accela.com/tigard/Default.aspx. From there, click on the Building tab, enter the permit number (PLM2020-00394) in the Record Number field, and click Search. Once paid, please notify us at TigardBuildingPermits@tigard-or.gov, and I will email the permit paperwork to you. Please let us know if you have questions. Thank you, Branden Taggart 7,1 n City of Tigard Senior Permit Technician Community Development 1312.5 SW Hall Blvd Tigard, OR 97223 (5031718-2449 brandent©tigard-or.gov 1