Permit CITY OF TIGARD PLUMBING PERMIT
111 '. COMMUNITY DEVELOPMENT Permit#: PLM2021-00154
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 4/15/2021
TIC ;112D 9
Parcel: 2S110BA04700
Jurisdiction: Tigard
Site address: 14383 SW MCFARLAND BLVD
Project: Hoober Subdivision: SHADOW HILLS Lot: 18
Project Description: Irrigation backflow preventer replacement
Contractor: WESTERN ROOTS LANDSCAPE Owner: HOOBER, DIANA R
3817 SE LIEBE ST 14383 SW MCFARLAND BLVD
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503-850-8242 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/14/2021 $31.27
Specifics: 1 12%State Surcharge- 04/14/2021 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/14/2021 $41.23
Class of Work: ALT 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 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: v1 ��� (fin ti /� Permittee Signature: 13n
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
Building Fixtures RECEIVE
City of Tigard Received hid/if Permit No:P�ZO21-OQ(5f
7 9 Date/By: U'`•f rd
13125 SW Hall Blvd.,Tigard,OR 97223 APR i 1 `U2' Plan Review
6 Phone: 503.718.2439 Fax: 503.598.1960
Date/By Other Permit No.
TIGw2i) Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: Iuris. ® See Page 2 for
Internet: www.tigard-or.gov Not]fied'Method. Supplemental Information
TYPE OF WORK may' FEE* SCHEDULE
❑New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. I Total
pAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OP CONSTRUCTION SFR(1)bath 312.70
52 I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
I:]Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ftJ Page 2
b ) s to ). a5 nr s#,O ll
)ORMATION AND LOCATION Site utilities:
Job site address: IL/365 .5f) I cJ 1 ) ✓ Catch basin or area drain 18.76
c /� JeLrr Drywell,leach line,or trench drain 18.76
T
City/State/ZIP: e Q c'170(a
Y Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Iloobt3,'/ 4,.4tt_ Manufactured home utilities 50.03
Cross street/directions to job site: i, t( 00,,,, v^ 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 Sl,a7
1i '/ Backwater valve 12.51
DESCRIPTION OF_ W ORK
r, Clothes washer 25.02
Irri 111 i n br.c..tI t,CLocJ pre..ient ref/ ([rptc� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02 I
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ 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/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: i Urinal 25.02
}ti) ` *..� � .iJ' '�t1D1.S( ?C `-ss Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:0,.., rn f,u� L t ce ee LIL., Water piping/DWV 56.29
Address: 367 5 Litz_ Other: 25.02
City/State/ZIP: ar oe c72 t Subtotal Zri;•J7
Minimumpermit fee: $72.50 Sly
Phone:(W3)6c ,_�co. Fax:( ) `��
QPB'ti LUi Le �d6 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) V 7 V
Authorized signature: TOTAL PERMIT FEE el .10
Print name: A/LA.5- / It41' Date:L.t0.21 This permit application expires if a permit is not obtained within 180 days
lI after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I 0/02/COM/WEB)