Permit CITY OF TIGARD PLUMBING PERMIT
11
.` v COMMUNITY DEVELOPMENT Permit#: PLM2021-003 1 3
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7l23/2021
Parcel: 2S112CC01801
Jurisdiction: Tigard
Site address: 8175 SW DURHAM RD
Project: Phan Subdivision: None Lot: None
Project Description: Installation of irrigation backflow.
Contractor: OWNER Owner: PHAN, CAROLINE LIVING TRUST
SLATTERY, KEVIN M
4635 CATALINA DR
SAN JOSE, CA 95129
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/23/2021 $31.27
Specifics: 1 12%State Surcharge- 07/23/2021 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 07/23/2021 $41.23
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total 381.20
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
Issued By: �' 'L'Y�i /��� Permittee Signature: 0 / r/ /` (--i G 771 /
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.
•
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Plumbing Permit Applica ECEIVE �_7 / Zl
Site Utilities V L V��{{ FOR OFFICE USE ONLY
Cityof Tigard JUL 2OZ Received //'' �/�/t //��,, j
11FP 25 gDate.�By7/ ZZ/7C 0 Peinth't7:141iC21- D Q•'Jl1 13125 SW Hall Blvd_,Tigard,OR 9P7,212-si,V t�C ^RDReviewr " I
V1 L)8 lJf I IGItfL/ Plnn
Phone: 503.718.2439 Fax, .503.5 I D Date/By: Other Permit No.:
Inspection Line: 503.639.4175 BUILDING DIVISION y L/ q�/t ,eels:
TICARD S I Date lead i6 7 Z Z "� ��}--� See Page 2 for
Internet www.Yigard OC gOv Notified/Meth j f- 14 t/1 I Supplemental Information
TYPE OF WORK FEE. SCIIEDULE
❑New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement R'Other. A eK _c_lo 3 New I-2-family dwellings(includes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
Er/I-and 2-family dvvel ling ❑Commercial/industrial SFR(2)bath 437.78
Accessor SFR(3)bath 500.32
ElY buildin g ❑Multi-family
leach additional bath/kitchen 25.02
❑ Master builder ❑Other:
_ Fire sprinkler( sy. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
.lob site address: I- W -7\,3/v 6.M �� Catch basin or area drain 18.76
1l��
City./State/ZIP:
�t iF�t V ct�2.a Footing
Drywell,leach line,or trench drain age 2
�� Footing drain(no. linear ft.:_) Paget
Suitelbldg.lapt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: s+kis.) c3\A 6,.\\ .- Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear It.: ) Page 2
Storm sewer(no. linear ft. _) Page 2
Water service(no. linear II.._) Page 2
Subdivision: I.ol no.: Fixture or item:
Tax map/parcel no.: Izs ze l S 1 BackFlow preventer I 31.27 31 27
DESCRIPTION OF WORK Backwater valve 12.51
bo,c,�- \ c- ./ �, • Clothes washerr25.02
-Y� � �� l���Q�� Dishwasher �
VVV 25.0.
�S ecY\ Drinking fountain 25.02
Ejectors/sump i 25.02
PROPERTY OWNER ❑ TENANT 1-:spansion tank 12.51
Name: KeJ le �Ia-y- ry ( (&rro`‘(\e ,Pk & Fixture/sewer cap 25.02
Address: g') /�l SV Urn c ry\ Floor drain/floor sink/hob 25.02
City/State/ZIP: c 1 Oft Q iR 9 7 2 Li Garbage disposal 25.02
J Hose bib 25 02
Phone:(469 y3 ga q0 Fax.( ) Ice maker-- 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/greuse trap 25.02
Business name: Medical gas(value:$_) Page 2
Contact name: Printer 12.51
Roof drain(commercial) 1251
Address:
Sink/basin/lavatory 25.02
City/State/LIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: 1te cY.101111ei 5bf.0\o1)(,X. !1Q/'� Urinal 25.02
:CONTRACTOR Water closet 25 02
Water heater 37.52
Business name:
Water ptpingrOWV 56.29
Address:
_.---- Other 25.02
City/State/ZIP: Subtotal 31 " j'
1
Phone: ----
( ) 1 Fax:( I Minimum permit fee: $72.50 .7,R Sri
CCI3 Lie.: Plumhil g Lie. no.: I Plan review (25%of permit fee) . '-'
y� State surcharge(12%of permit fee) r�P''r70
Authorized signature: '// • �� �� - �n ��
L / ~"�" TOTAL.PERMIT FEE •
_}�J
Print name: r Cs/inn ..SIQ -Ebes-`/ IfDale: 71(a l ,t 'Ii-ris permit application expires if a permit is not obtained within 0 days
/7s 1I after it bys been accepted as complete. / !l
*Fee md
methodology set by Tri-County Building Industry Service mob.
V
i.‘Building\Pere is\PLML'-PennitApp.dac 10/01/09 440-46trTt 10102'COM.WEB)
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
isI will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
KEVi,J S2A-1-TEie�
Print Na e of Permit Applicant
7- 14—z /
ignature of Permit Applicant Date
Permit#: _14)4-M 2.0 21 r17C 3/3 , F
Address: F/ 7s —SLsI Zt 64.9-t/ "1)
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Issued by: Date:
This Copy for Permit Offices