Permit NIP PLUMBING PERMIT
CITY ®F 1'IG,�R® W Permit #: PLM2010 -00147
GIRD COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/05/2010
r: nc'1'r.[P;3 Parcel: 2S104AC07800
Jurisdiction: Tigard
Site address: 12734 SW MORNING HILL CT
Subdivision: MORNING HILL NO. 9 Lot: 221
Project: Benevento
Project Description: Backflow preventer
Owner: FEES
BENEVENTO, RICHARD P & JULIE A Quantity Description Date Amount
12734 SW MORNING HILL CT
TIGARD, OR 97223 1 ea Backflow Preventer 05/05/2010 $31.27
PHONE: 1 12% State Surcharge - 05/05/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 05/05/2010 $41.23
Contractor: Plumbing
GREEN MEADOWS LANDCARE, LLC
11854 SW CHATEAU
WOODBURN, OR 97071
PHONE: 503 - 710 -2348
FAX:
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 obtai . y of the.rr1(es
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By PAN / 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 Application
Building Fixtures FOR OFFICE USE ONLY
�
City of Tigard Received
Date/By: Permit No.. M d 94 0 1 U %r
V 13125 SW Hall Blvd., Tigard, OR 97223 D /y
NI 0 .:. . Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No
Date/B`
TIGARD Inspection Line: 503.639.4175 Date Read■By. Jinu. El See Page 2 for
Internet: www.tigard or.gov Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition alteration replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- 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: 73 Y SW MORNING HILL CT Catch basin or area drain 18.76
1 Drywell, leach line, or trench drain 18.76
City State ZIP: TIGARD
Footing drain (no. linear 11.: ) Page 2
Suite bldg. apt. no.: I Project name: BENEVENTO Manufactured home utilities 50.03
Cross street directions to job site: SW 131 AVE Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear It: ) Page 2
Storm sewer (no. linear lt.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK • Backwater valve 12.51
Clothes washer 25.02
INSTALL BACKFLOW PREVENTION DEVICE FOR IRRIGTATION SYSTEM
Dishwasher 25.02
Drinking tbuntain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City State ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
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
Urinal 25.02
E -mail:
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: GREEN MEADOWS LANDCARE LLC Water piping /DWV 56.29
Address: 11854 NE CHATEAU DR Other: 25.02
City State ZIP: WOODBURN Subtotal 31.27
Phone: (503) 710 - 2348 Fax: ( ) Minimum permit fee: $72.50 72.50
0 Plan review (25% of permit fee)
CCB Lic.: LCB 8620 Plumbing Lk. no.:
State surcharge (12% of permit fee)
Authorized signature 7 TOTAL PERMIT FEE
Print name: RO S :R' RTE P Dale: 05/04 /2010 This permit application expires if a permit is not obtained within 180 days
alter it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.