Permit ,'n CITY OF TIGARD
PLUMBING PERMIT
` '' COMMUNITY DEVELOPMENT Permit #: PLM2010 00192
u rr Date Issued: 06/11/2010
fit 1 G AR Ei 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S104BA04000
Jurisdiction: Tigard
Site address: 13982 SW NORTHVIEW DR
Subdivision: CASTLE HILL NO. 2 Lot: 73
Project: Kintz
Project Description: Backflow installation.
Owner: FEES
KINTZ, CHRIS Quantity Description Date Amount
13982 SW NORTHVIEW DR 1 ea Backflow Preventer 06/11/2010 $31.27
TIGARD, OR 97223 1 12% State Surcharge - 06/11/2010 $8.70
PHONE: Plumbing
41 ea Minimum Fee Adjustment - 06/11/2010 $41.23
Plumbing
Contractor:
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 503.2 ' • • • • • or 1 :: x.332.2344.
Issued By: �� Permittee Signature: ' / `
1
/
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.
JUN -11 -2010 10:06 FROM- 5033579910 T -696 P.001 /002 F -559
Piumbine Fermit Application
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t City of Tigard t y.. �1 Day! B v: / it 6 _ /i- 1h3olo
-4 0 1312. SW Hall Blvd., Tigard, O1 9722 � an Icoicw
t J l� Oilier Permit No.:
q ?hon. .: 503.639.4171 Fax: 503.598,1960 - -fit:? c4 al,sy.
, , �, In6pe. :tiof Line: 503.639.4175 CS c \ \ \' Date Rowdy /By: hal, IM Sec Pate 2 for
rTIGAKD' e �*. 1 Notificd/MelhlU: 01 , Supplemental Information
�: � Interl ct: www,tigard�+r.. , c,
. TYPT.,OI?WOltitr i �� ; ,CiM .,.'',
0 Ncw construcriot, 1 ❑ Demolition Fur special in fi rrnation use checklist.
Descri•tion Oty, MBE Total
❑ Addition /alteratit.n/replaccntcnt ❑ Other: New 1- 2- family dwelling (includes 100 ft. for each utility connection)
CATEGORY OF •CQNSfRt1C•l'IO N
. SFR (1) bath 312.70
Commercial/industrial SrR (2) bath x37,78
(] 1 -and 2- family ur,elling ❑ _ �--
_ �t�R(3)baih 500.32
❑ Accessory buildiog ❑ Multi- family -
Each addilionul bath /kitchen 25.02
❑ Master builder E Other: Fire sprinkler ( :+q. 11 ) Page 2
,)OI3 SITE INFORMATION AND LOCATION • . Site utilities:
Catch basin or area drain 18.76
Job site address: 398 s o >• k(4v i,I r.
Drywel1, leach lint, or trench drain 18.76
City/State/ZIP; • ' f,bir, Ji 2 l` ` 01�ZZ _ hooting dtaiel (na.linearit.: _) Page 2
Suitc/bldg. /apt. no,: Project niunc: K(�7.. Manul home utilittcs 50.03
Cross streevdirectio i lO Job s¢c: l�(Ur'twie,,,,t t f- 1- $W ["1 [ i jai- - Manholes 18.76
l Rain drain connector 18.76
Sanitary ewer (no. linear R.: ) WM -- °-
- Sturm scwcr (no. linear it : ) Page 2
Water st (no. linear ft. _ ) Page 2 _.
Subdivision: et.. _f t. Iiil l Lot nu.: 4 Fixture or_item: •
Tax map/parcel no.: - Ba,.kflow prevenler J 31.27 1 ) i,Z
. Backwater valve
j 12.51
T - rnSgRIPTION :Q ' WORk.' . , . ' . ,
- Clothes washer 25.02
A.) Ct44.tif. ,'1yi.,I( - teli"4 it u i„,e4e/ 6, u%
Dishwasher 25.02
)rr', ti (1 44 1 ' Sle Drinking fountain 25.02
J Ejectors/sump 25.02
_ ,. ---
m PROPERTY • OWNER' ' . ❑ TENANT Expansion tank 12.51
v . Fixture /scwcr cap 25.02
Name: t,tbr, .1 hint,;
Floor drain/floor sink/hub 25,03
Address: 4.19e Se,/ /Y.,. - •"c:,. Or .. Garbage disposal 25.02
City /State /ZIP: T iSG , o+Z ‘772/1 Elosc bib - ■ 25.02
Phone: ( t3 ) j - � Fax ( ) Ice maker 12.51
lnterccotorl' lease u;, p 25.02
❑ �PPLtCANT 0. CONTACT PERSON _ ere
Medical pas (value: 5 ) Page 2
Business name: "'
Primer 12.51
Contact name: Root drain (commercial) 12.51
Address: Sink/basin /lavatory 25.02
City/Start /ZTP: Solar units (potable walci) 62.54
Phone: ( ) Fax: ; ( ) Tub /shower /shower pan 12.51
-- - - Urinal 25.02
E -mail;
- - - Water closet 25.02
CONThACTOR' Water heater 37.52
Business name: ) 0 Waterpipinp /DEW 56.29
Address: Other: 25.02
City/State /ZIP: Subtotal
Fh-
Phone:( ) Fax: ( ) -
Minimum permit fee: $72,50 $72,0
- - Plan review (25% of permit fec)
CC13 Lic.: Plumbing Lic. no.! - .. State xlrcl large (12% of permiI. fee) ,rg .. -.4„
Authorized signatu , c: - , TOTAL PERMI'l'FEE 48j.4,2
Thi6 permit apptic:aiuu eN parts If a permit i. nor obtained within ISO days
Print name_ et, r� t ,nr Dal` ,L,,7/O . it ha. Oven accepted as rotnplete.
"Fee ,ne:lindology set by Tri- Coaniy Building Industry Service Board
f:,Bi,Idina \Werm ecr ,nlAy)aoc 10/01/09 , 140 -4616 T(I t)a(7's,CO,NI,W OB)
JUN -11 -2010 10:06 FROM- 5033579910 T -696 P.002/002 F -559
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Property Owner Statement
Regarding Construction Responsibilities GA
' CITY OF T RD
Oregon Law requires residential construction permit applicants who are not licensed with DIVISION
Construction Contractors Board to sign the following statement before a building permit can be
issued, (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please cr►eck the appropriate box
-1 I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Pate
1 will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
•
will be performing work on property I own, a residence that 1 reside in, or a residence that 1 will
reside in. If 1 hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
is iuing this Building Permit.
•
1 have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and 1 hereby certify that the information on this homeowner statement is true and accurate.
Print Name of Permit Applicant
Signature of PefmitApplicant Date
Pr:rmit #:
f r � } •
I ssued by; pale. 1
This Copy for Permit Offices