Permit PLUMBING PERMIT
CITY OF TIGARD
m . COMMUNITY DEVELOPMENT Permit #: PLM2010 -00164
! Date Issued: 05/21/2010
TiGARD.; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S1 11 AC04800
Jurisdiction: Tigard
Site address: 14855 SW 92ND AVE
Subdivision: LAUNALYNDA PARK Lot: 16
Project: DeVore
Project Description: Install irrigation backflow device.
Owner: FEES
DEVORE, RUSSELL J & Quantity Description Date Amount
14855 SW 92ND AVE
TIGARD, OR 97224 1 ea Backflow Preventer 05/21/2010 $31.27
PHONE: 503-888-1172 1 12% State Surcharge - 05/21/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 05/21/2010 $41.23
Contractor: Plumbing
OWNER
PHONE:
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
7
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 Application
Site Utilities RECEIVED FOR OFFICE USE ONLY
City of Tigard Received
Date/By:' / ' /D ����' Permit No.:P(J70 /60 d 0 /Lii /
III n 13125 SW Hall Blvd., Tigard, O W 22 1 2010 Plan Review
C - Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Date/By:
T I G A R D Inspection Line: 503.639.41 CITY OF TIGARD Date Ready/By:
�i See Page 2 for
Internet: www.tigard -o DIVISION c 1 IILDING DIVISION Notified/Method: '7 C(j Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 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 - famil
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: 14855 SW 92 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: Cross Street is Heidi Court. Manholes 18.76
Residence is located on the north side of Heidi Court along SW 92 Ave 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: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Backflow preventer being installed for sprinkler system.
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Russell DeVore Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: 14855 SW 92 Ave
Garbage disposal 25.02
City /State /ZIP: Tigard/ OR/ 97224 Hose bib 25.02
Phone: (503)888 -1172 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: O Gt/ N ER Water piping/DWV 56.29
Address: S/f j Other: ' 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( )
Minimum permit fee: $72.50 7a , 5 - n
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
/1 State surcharge (12% of permit fee) r -70 Authorized signature: �// TOTAL PERMIT FEE 7/, An
Print name: -V SS G l�V 'C_ V0 e.,V Date: 5' - Li- / 0 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.
1:\ Building Termits\PLMU- PermitApp.doe 10/01/09 440- 4616T(10 /02 /COM/WEB)