Permit (14) CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2023-00441
T I(;A R I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2023
Parcel: 2S111AA02400
Jurisdiction: Tigard
Site address: 14385 SW 86TH AVE
Project: Robbins Subdivision: GREENSWARD PARK
Lot: 14
Project Description: Install(1)backflow preventer.
Contractor: S RIVER LANDSCAPE AND CONSTRUCTION LLC Owner: SUNDANCE HOMES&REMODEL INC
513 E 16TH ST APT B-21 17420 SW 110TH AVE
VANCOUVER,WA 98663 TUALATIN,OR 97062
PHONE: 503-744-1417 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/16/2023 $31.27
Specifics: 1 12%State Surcharge- 10/16/2023 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 10/16/2023 $41.23
Class of Work: NEW 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 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 ay obtain a copy o the rules
Issued By: 914/1 Permittee Signature:
Call 503.639.4175 b :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
Site Utilities RECEIVE
Cityof Tigard Received ®� �h
Iii • 13125 SW Hallll Blvd.,Tigard,OR 97223 0�,'T , c 2023 Date/By: ( O (6 a a Perrn; c.�-O a3_ t'tI
Phone: 503.718.2439 Fax: 503.598.1960 6 Date/By:Plan Review Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGARDReady/By:C t G n R 1� Internet: www.ti and-or. ov Date Rd/ t Juris: Supplemental
See Page 2 for
g g Notified/Method: Supplemental Information
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❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
; �,,,, .,, .r � it oAtAv- x SFR(1)bath 312.70
g.
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other Fire sprinkler( sq.ft.) Page 2
`�3 , 46,.',A. '... .. �,,, , .,4*.k .,4, ,e,.,,..5. s y '�,c P, site utilities:
Job site address: 14385 SW 86th Ave
Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: TIGARD,OR.97224 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
HALL BLVD.SOUTH.TURN LEFT ON TO GREENSWARD LN.THEN TURN LEFT ON TO 86TH 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: GREENSWARD PARK , Lot no.: 14 Fixture or item:
Tax map/parcel no.: 2S 111 AA02400 Backflow preventer 1 31.27 31.27
h a l in € r Backwater valve 12.51
k. r � , ,,. a ..Zwr ), t i <"=- Clothes washer 25.02
LANDSCAPING BACKFLOW PREVENTER Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
' : € 4 al € r n....,y � "ow Expansion tank 12.51
,, . J -,, � '
Name: SCOTT ROBBINS Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17420 SW 110TH AVE
Garbage disposal 25.02
City/State/ZIP: TUALATIN, OR 97062 Hose bib 25.02
Phone:(503)969-1233 Fax ( ) Ice maker 12.51
, € � ;.5 rz 4e€,',44N r ' � +sd .s.- € Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: SAME
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: Urinal 25.02
,. a z PL :' 0€ g k € / ..s . Water closet
25.02
. , ,, . .. . ..„.4.. .... . .1V6,;-"*v:: .x ,..,,a . „ Water heater 37.52
Business name: S RIVER LANDSCAPE AND CONSTRUCTION LLC Water piping/DWV 56.29
Address: 15715 SW 133rd AVE Other: 25.02
City/State/ZIP: PORTLAND, OR 97224 Subtotal
Phone:( 503) 744-1417 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 224595 Plumbing Lic.no.: 9713 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: SCOTT ROBBI NS Date: 10/16/2023 This permit application expires if a permit is not obtained within 180 days
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(10/02/COM/WEB)