Permit W
71 OF TIGARD PLUMBING PERMIT
Y a Y a - COMMUNITY DEVELOPMENT Permit #: PLM2010 -00130
e Date Issued: 04/23/2010
y iGARLi 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S133DD13400
Jurisdiction: Tigard
Site address: 11866 SW 127TH PL
Subdivision: VILLAGE AT SUMMER LAKE NO. 4 Lot: 171
Project: Hodgkinson
Project Description: Residential irrigation backflow device.
Owner: FEES
WILLIAMS, SUSAN Quantity Description Date Amount
11866 SW 127TH PL
TIGARD, OR 97223 1 ea Backfow Preventer 04/23/2010 $31.27
PHONE: 503 524 -6494 1 12% State Surcharge - 04/23/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 04/23/2010 $41.23
Contractor: Plumbing
ALL NATURAL LANDSCAPE INC
PO BOX 2815
CLACKAMAS, OR 97015
PHONE: 503 - 740 -7733
FAX: 503 - 536 -6535
Type of Use: SF
Class of Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Applicati l !, n `
Site �Jtilities �"
1 3 1 of Tigard APR 2 2 2010 eB y /is�� ,4j Permit No.:PLt yad7o, - Oai3d
r 13125 SW Hall Blvd., Tigard, OR 97223 • Plan Review
Phone: 501639.4171 Fax: 503.598.dba..
1 I OF TIGARD > y: Other Permit No.:
Inspection Line: 503.639.4175 D ate R B 0 See Page 2 for
TrI G:� R D Internet: tigard or.gov BUILDING DIVISION Not fi etl is Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. I Total
❑ Addition / alteration /replacement �p..9Ater: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 t `b 6 (p - i , 0. f L. Catch basin or area drain 18.76
` \ Drywell, leach line, or trench drain 18.76
City/State/ZIP:
-�� 10 b - C FA' o Footing drain (no. linear ft.: ) Page 2
Suite/bldgJapt. no.: I Project name: ..V..\ c c sa`^\ . Manufactured home utilities - -- 50.03 - - -
Cross street/directions to job site: Manholes 18.76
k 54; 4 s- VI k �c.r\ le_ Of... Rain drain connector 18.76
r�' 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 g f ,
• DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
- - -
r Dishwasher 25.02
RS f 2( Ca-i /O /J .(i-(t _F(d k) A /( (�� Drinking fountain 25.02
-- Ejectors/sump 25.02
, J4ROPERTY OWNER l ❑ TENANT Expansion tank 12.51
Name: c i.�.S3.11 A. bt ,,, `a h 4- ∎
Fixture/sewer cap 25.02
I 1 to C - Ia � f Floor drain floor sink/hub 25.02
Address: cg Garbage disposal 25.02
City/State/ZIPI t ' n U - 9,- p� Hose bib 25.02
Ff
Phone: ( ...ca rn 1._ t (4 4 Fax: ( ) Ice maker 12.51
• ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: X>y \ \ Vj�( \ G Medical gas (value: $ ) Page 2
` _ S 15Lt� Primer 12.51
Contact name:
�r .� u"' n Roof drain (commercial) 12.51
Address: Y , b , IA t' a -, S - vo c,LIA,..t l4_ 6L„ Sink/basin/lavatory 25.02
i
City/State/ZIP: `1 -4:433 - -1 'a 1 c- Solar units (potable water) 62.54
Phone: (Gt3) - 4 ( 1 6- Fax: : ( ) % Tub /shower /shower pan 12.51
E- maiL•.rM l V aj I n t7.-+ VI / i I .01.'4A 5c.ct e, . C cry-) Urinal 25.02
CONTRACTOR Water closet 25.02
j Water ter heater piping 37.52
Business name: 1 , �1, Wa /D WV
56.29
Address: �� - "'v Q.�t��.RJ Other: �z..x ".�. -.may t
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Mini um permit fee: $72.50 ' a.- TO
• • B Lic.: G�/ Plumbing Lic. no.:
I ■ Plan rev: w (25 % of permit fee)
Q % State surch: 1: 12% of permit fee) ez 0
Authorized signatur � ( /// 0 TOTAL • :* . " ' f f)/, 9..6
Pri nt name: - '` �� Date: I I This permit appli expires if a permit is not obtained within 180 days
Z O `V e,(Lc LU.. -S c .� after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\ BuildingTermiu U'LMU- PermitApp.doc 10/01/09 440- 4616T(10/02/COM/WFB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11866 SW 127TH PL, TIGARD, OR, 97223 July 23, 2018 at 7:14:38 AM
Record Type: Record ID:
Residential - Plumbing PLM2010-00130
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor