Permit rr CITY OF TIGARD PLUMBING PERMIT
•
2 : COMMUNITY DEVELOPMENT Permit #: PLM2010 -00141
13125 SW Hall Blvd., Ti Date Issued: 04/29/2010
Tigard OR 97223 503.639.4171
TIGARD' 9
Parcel: 2S103BB03200
Jurisdiction: Tigard
Site address: 12198 SW 125TH AVE
Subdivision: BROOKWAY Lot: 32
Project: Sprague
Project Description: Residential irrigation backflow device.
Owner: FEES
SPRAGUE, DAWN M Quantity Description Date Amount
12198 SW 125TH AVE
TIGARD, OR 97223 1 ea Backflow Preventer 04/29/2010 $31.27
PHONE: 1 12% State Surcharge - 04/29/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 04/29/2010 $41.23
Contractor: Plumbing
PROGRASS INC.
29895 SW KINSMAN RD
WILSONVILLE, OR 97070
PHONE: 503 - 682 -6076
FAX: 503 - 682 -9876
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: 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.
7
Plumbing Permit Application E�
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Phone: 503.639.4171 Fax: 503.59 r9 R 2 6' 20 1Q Received
Permit Nop
II/ n j!}(iJ r6 4,69,/,/
3 ` Date /By: ❑Yr41//G' w i
. n 13125 SW Hall Blvd., Tigard, OR 2
Plan Review
.. TIGA Other Permit No.: G L ❑ ❑
R Date /By: ❑ 0 0 ❑
Inspection Line: 503.639.4175 Cl DIVISION
Date Ready/By: ❑ L E D O l 0 See Pa e 2 for
TIGARD Internet: www. 3rd -or. ov G ION r 6(
g g BUll DING 00 =7 1 Supplemental Information
TYPE OF WORK
❑
Nev construction Ill Demolition
FEE* SCHEDULE
For special information use checklist.
Addition/alteration/replacement ❑ Other. ❑ ❑ ❑ ❑ ❑ Description 1 Qty. 1 Ea. 1 'Total
CATEGORY OF CONSTRUCTION New 1- 2- family dwellings (includes 100 ft. for each utility connection)
SFR(1)bath D0 312.70 iH?JJ[
1- and 2- fancily dwelling ❑ Commercial /industrial
SFR (2) bath HE 437.78 11. 1,7
❑ Accessory building ❑ Multi - family SFR (3) bath 1110 500.32 ,. Ii :C
❑ Master builder ❑ Other: ELIDED Each additional bath /kitchen 1 C 25.02 1 1
JO13 SITE INFORMATION AND LOCATION Fire sprinkler (D 0 0 0 0 sq. ft.) ELL L Page 2 1. 1 a[ i Fl D
Job site address: 0 D 0 0 0 `z` c t L :3:.;•..i \ 2_S
S T A1/4.i Site utilities:
;� Catch basin or area drain DE 18.76 00000
City /State /ZIP: ❑ ❑ 0 11 ► ����� 1L _ Drvwell, leach line, or trench drain n f7 18.76 f l_r 1 DE
Suite /bldg. /apt. no.: 0 0 ❑ ❑ D Project name: 0 D 0 0 ❑ Si •c,L.) C� Footing drain (no. linear ft.: 0 0 0 0) J `-I Page 2 1.:.11:0 HE
Cross street/directions to job site: 0 0 0 0 0 Manufactured home utilities I_i C. 50.03 =1 J ❑ 0 0
000 -10 Manholes DE 18.76 00000
Rain drain connector LI ❑ 18.76 11;10 ❑ 0
0E10E0
Sanitary sewer (no. linear ft.: ' I 0 E' Page 2 17 D D [ I D
❑❑0170
Storm sewer (no. linear ft.: 00 0 D) L I E ❑ Page 2 ❑ 0 ❑ D ❑
Subdivision: 0 ❑ 0 0 ❑ Lot no.: ❑ ❑ 0 ❑ D Water service (no. linear ft.: 0 0 -! Page 2 0'0 CI 0 E
Tax map /parcel no.: DOCILE Fixture or item:
DESCRIPTION OF WORK Backflow preventer 7 C. 31.27 U E C 17
Backwater valve \ ❑ D 12.51 v2_7
❑ 0 0 0 ❑ LL -- F7PC_IL c-O
l t � j - � � Clothes washer CI ❑ 25.02 [ ] D G iJ ❑
111DD'0❑ I2_I„1�L,L-- S■.IS('�tv\ Dishwasher HHL 25.02 07000
❑ 0 ❑ ❑ E Drinking fountain EH 1 25.02 0 0 ❑ ❑
❑ PROPERTY OWNER ❑ TENANT Ejectors /sump DE 25.02 i I'=J 07'E
Name: 0 D 0 D 0 �P.e� a `'? �� Expansion tank [1 12.51 ; ❑'7
Fixture /sewer cap [ ❑ 25.02 ,! J LI J C
Address: El 0 0 0 Siss M' Floor drain/floor sink/hub HE [1 25.02 I U U L 0
City /State /ZIP: D ❑ ❑ D ❑ Garbage disposal ❑ D 25.02 [ ! 7 J C
Phone:(❑❑❑❑❑)❑❑❑❑❑ Fax:(❑❑ ❑ ❑D)❑ ❑D ❑D Hose bib DD 25.02 0 =DU
❑ APPLICANT ❑ CONTACT PERSON Ice maker 0 0 12.51 H Ei J D D
Business name: 0 III ❑ 0 ❑ l _t c -Q A SS ( ..3 L Interceptor grease trap ❑ ❑ 25.02 ❑ 0 ❑
y i-,1 t Medical gas (value: $ 00000 ) ❑ ❑ Page 2 J 0,17 0
Contact name: ❑ ❑ ❑ ❑ ❑
Z� 9 ,s� �t"S61 A P Primer
ODE 12.51 ❑CI ❑U
Address: 1010000 ` o� t ��t p� 7 a ? Roof drain (commercial) 0 ❑ 12.5 I D :J 0 C ❑
C City /State /ZIP: 00 ❑0D �(;y1.ti�_6 �L� l Sink/basin/lavatory 0 25.02 7 I7
Phone: (0000❑)S D Z(op Fax: :(❑❑0D ❑)X5102 Tub Solar units (potable water) 0 62.54 ..
❑ II II ❑ Z 0--- Tub /shower /shower pan D ❑ 12.51 ! J ;L Ell' '
E-mail: '
�z;1A Q e► o C. �Z.ASS . Co C o
Urinal DO 25.02 7EE17J
CONTRACTOR
Water closet 00 25.02 III0Li.'❑
Business name: ❑ ❑ 0 ❑ ❑ Water heater 0 0 37.52 1" 0'' =i
Address: 0 0 0 ❑❑ Water piping/DW V 0 D 56.29 1710 f 7 : 0
City /State / /_IP: ❑ ❑0 ❑❑ Other: 00000 DE 25.02 IJDCE,[
(l Subtotal 12
„'ST(
Phone:(OD ❑0❑)❑ ❑ ❑D❑ 131 Fax:(00000)0000❑
�(,11..F�f3'Lic.: El D 0 0 , , J Plumbing Lic. no.: ❑ ❑ ❑ ❑ ❑ Minimum permit fee: $72.50 _77 f y"6
/Z Plan review (25% of permit fee) 110 DE E Authorized signature: e"----TM 1 Z�1 o State surcharge (12% of' permit fee) ❑LS177:p
Print name: DO ❑0 ❑- -a \ \ J (-� ��` i CZ Date: 0000❑ TOTALPERMI "I'FEE EEL
1:A Building V Permits VPLMU- PermitApp.doc 10/01/09 440- 4616T(I0 /02/COM/WEB) ci ,2 L