Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00517
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/29/2020
T I r' Iz p g Parcel: 2S110DA00300
Jurisdiction: Tigard
Site address: 10893 SW LADY MARION DR
Project: Trillium Hills Subdivision: TRILLIUM HILL Lot:
Project Description: Backflow installation for streetside LIDA planters to Trillium Hills subdivision. The addresses included are 10893,
10894 SW Lady Marion Dr.and 15199 SW Tierra Ter.
Contractor: SUMMIT LANDSCAPE LLC Owner: CASCADE CIVIL DEVELOPMENT INC
PO BOX 3610 PO BOX 1060
HILLSBORO, OR 97123 WOODBURN, OR 97071
PHONE: 503-380-7618 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/29/2020 $31.27
Specifics: 1 12%State Surcharge- 12/29/2020 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 12/29/2020 $41.23
Class of Work: OTR Plumbing
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 a 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 503 987 or 1.800.332.2344.
Issued By: --'fife'11/ Permittee Signature: A/ /ngeWee %
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
Thi. ermit 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 6- 12 1 , 20
Building Fixtures RECEIVED I Irk tt, t ,t ( i .I tl.l ,
City of Tigard D.e�( �p %�J Pn,nit xn.:P1��(��(j
13125 SW Hall Blvd.,Tigard,OR 97223 DEC 16 2020 y�
Phone: 503.718.2439 Fax: 503.598.( 6 Plan Revue
Q.,, ewer Other Permit No.:
1,7
Inspecuon Ltnc 503 639.4175 l 1 1 1 OF TI GARD pate ReadyBy J'rn 0 See Page 2 for
Internet: www(Igard of gov BUJLPING Qlvl N Nonfied7Method• '777 Stqi(lesneatal lnformedse
- c ,' F is tr '- ?�..F'�1 An1�.+G r� � � ;1 ,. ... ' �^ r v;'; ..c r ..,,,
)(New construction ❑Demolition For special iwjarmation a e cheekhst
Description 1 Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
''- . r. SFR 1)bath 312.70
c < „ x . "i-, • • • .. s
SFR(2)bath 437.78
l and 2-family dwelling []Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitcben 25.02
0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
4 E*nR ikiatukuktii* ' ?41.0- : Site utilities:
Job site address. tn6(�/i Ski
Catch basin or area drain 18.76
vVvP T �wlJ prywell,leach tine,or trench drain 18.76
City/State/ZIP: -1 i° t 04 o1'7,?11 Lod'Marian Er.
gigs Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.. Project name: - oli(l(A Ws 1'Fr gas 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
e
Water service(no.linear ft.:,,,_,_J Page 2
Subdivision: 7,71111 .• '� Lot no.: Fixture or item:
Tax map/parcel no.: Backtlow preventer / 31.27 31 )7
Y,.; *" Backwater valve 12.51
Jt... 1 �'. �r ,ri„i=^;�S'z `- '' Cl(/II1CS Waa11Cf 25.02
J. j nCIMI l A•fieSt POI ts4vol- Sr ll1 Dishwasher 25.02
1IpW ?IdA1LYS and 64 of 7 YLI .. _ Drinking fountain 25.02
Ejectors/sump 25.02
/y�y�Jp.aye/� a�. ' f�M,}{ Expansitm tank 12.51
Name:
Fixture sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
£ j 0tosithertudimo ' Interceptor/grease trap 25.02
Business name: S1MIN'11+ Lgv1{S(apc. L!_Iry Medical gas(value:S_) Page 2
Conrad name: (� r a(/ 1 Primer , 12.51
V I'1Q� f r`� --- Roof drain(comet ial) 12.51
Address: PO got gulpSinkrbasin/lavatory' 25.02
City/State/ZIP: d'f► cb {) et 1 1 r 3 1a, ca C/,aria: Solar units(potable'water) 62.54
Phone:( ) - Fax::( ) 1187 Tub showerlshowepan 12.51
marl r Urinal 25.02
E
ram! !" et1k, „ Water closet 25.02
37.52
Business name: 5�w)ml1 Le*0-4')(T 2,, Wnler piping/DWY 56.29
Address: Other: _ 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: S72.50
CCB Lie.: e7 /L- _ PI ing Lic.no.: Plan review (25%of permit fee)
- State surcharge(12%of permit fee)
Authorized signature: ( TOTAL PERMIT FEE ,51. 7-12
Ia
[Print name: 4 k'( Date: kp ifj-- This permit spline don expires if a permit Is not obtained within mu days
1 atter It bat been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
I'dludthngPerna.'PI.MU.PmniApp.doe I0411/09 440.4616(10/02iCoM/WEB)