Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00259
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/21/2021
Parcel: 1S135BC00500
Jurisdiction: Tigard
Site address: 10770 SW CASCADE AVE
Project: Harley Davidson Subdivision: None Lot: None
Project Description: Replace irrigation backflow.
Contractor: LOVETT INC Owner: JOHN DURBIN &ASSOCIATES OREGON LLC
PO BOX 86280 BY DURBIN CHOPPERS
PORTLAND, OR 97286 ATTN DURBIN, MICHAEL
10770 SW CASCADE AVE
TIGARD, OR 97223
PHONE: 503-737-8423 PHONE:
FAX: 503-288-1630
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/21/2021 $31.27
Specifics: 1 12%State Surcharge- 06/21/2021 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 06/21/2021 $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 952-001-0010 through 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: „�/(/ 4G Permittee Signature:
dW L./�
./� (COX �7�Y--� /C_I--% 74111
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 Applica cCEIVED V- S1?
Building Fixtures JUN 15 2021
City of Tigard �j Received// //c permit No.F[,M zD z I_ Do 7
Iliiq 13125 SW hall Blvd.,Tigard,OR Taint OF TIGARD Date/By. , 2/
Plan Rev
Phone: 503.718.2439 Fax: 503 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 'WING DIVISION Date/BY: /B -
f I G A I�D Internet: www.ti ardor. ov y o ,/t /74/ 6' s "tee Pent i for
g K NotifiedRviethod. 2`4 j 1;--• Supplemental Information
'FITE OF WORK FEE* SCi3EDl1LF;
Forspecial
ID New construction ❑Demolition -- information use checklist
Description I Qly. I Ea. I Total
)gaddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION ION SFR(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Oiler: Fire sprinkler( sq.ft.) Page 2
JOB Sl"1'E INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: ' A\i-C.
�-- • Dryweit,leach line,or trench drain 18.76
City/State/ZIP: t t -� 3•90 Footing drain(no.linear ft.: ) Page 2
Suite/bidg./apt.no.: Project name: I-1(0(-4 I(0 Lig
J 2 Manufactured home utilities 50.03
Cross street/directions to job site: I-M-iQ•�, )).L. 'b 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 Wrap/parcel nn.: - Backflow preventer - 31.27 'St
Backwater valve 12.51
DESCRIPTION OF WORK -__T--
Clothes washer 25.02
i ..0\c ,a ck . l `,Ck\iLx.t.c i \_ Dishwasher 25.02
.\- - ���Y\ - (')&- �'1/ _--_ _ Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
_ gziol�i�Iirst owcvEil ;: > .. «} .�..1=7 ? `! "�' P
Name: I . V Fixture/sewer cap 25.02
(�
Floor drain/floor sink/hub 25.02
Address:
0 o S� 6,1 ccirL ^vt., Garbage disposal 25.02
City/State/ZIP: ¶ ctp rj-j t l" --
tY ` ) J�� '" �3 Bose bib 25.02
Phone:(a3) 3(p`3..c (p e30i 3 Fax ( ) Ice maker 12.51
tinAPPLItANT :. CONTC P } . ' Interceptor/grease rease trap25.02
�r �, ,
Business name: �.j f. J
Medical gas(value:$ ) Page 2
Contact name: C� � Primer 12.51
`� 0_11.t �LOtiry1 Roof drain(commercial) 12.51
Address: (09' 0 At)t. L-t�r` Ait Sink/basin/lavatory 25.02
City/State/ZIP: ?of-44_ ,Jr-t C4 e'v-(9f$ Solar units(potable water) 62.54
Phone:( 3)•7.31-et/2 3 t Fax::( ) Tub/shower/shower pan 12.51
E-mail: ?e_"1ti1t't3- �.) it)t/ed+8.e-Y'J(c.c..s. ('t7/"'� Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37,52
Business name: L>ie±LServ1�C.A..,:l Water p•P irl r in DWV 56.29
Address: 6goo AJ LP'frig e Other: 25.02
City/State/ZIP: del a t 8 Subtotal
Phone:(5 )3 ) 3_�/7,3 Fax:( ) Minimum permit fee: $72.50
CCD Lie.: 1 aS-s U.-- Plumbing Lie.no.:9.&--1 3 05 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
1
Authorized signature: r� e� .�-�'"'` TOTAL PERMIT FEE ,F '�
Print name: r�o ,' �j Date: i This permit application expires if a permit is not obtained within 180 days
1L {'� OI. c cYf., / L• after It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Hoard.
I:1Buildiug\Permits1PIMU-PamitApp.doe 10101/09 440.4616T(10/02/COAVIVEB)