Permit
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit PLM2009-00322
0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2009
Parcel: 2S103DB06900
Jurisdiction: Tigard
Site address: 11170 SW EDEN CT
Subdivision: Lot: 0
Project: Vanderschoot
Project Description: Irrigation backflow device.
Owner: FEES
VANDERSCHOOT, HENS C & DONNA M Quantity Description Date Amount
1170 SW EDEN CT
1170 S EDEN CT 1 ea Backflow Preventer 11/04/2009 $31.27
PHONE: 503-968-8295 1 Plumbing State Surcharge - 1110412009 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 11/04/2009 $41.23
Plumbing
Contractor:
DENNIS' SEVEN DEES LANDSCAPING INC
7355 SE JOHNSON CK BLVD
PORTLAND, OR 97206-9329
PHONE: 503-777-7777
FAX: 503-777-2399
Type of Use: SF
Class of Work: OTR 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.
Pla mbing Permit Application 6l/-7<o-0/' s- /l
FOR OFF ICE USE ONLY
Site Utilities
of Tigard RECEIVED Received -,Ave Permit No~`"C Gt P'
City
n 13125 SW Hall Blvd., Tigard, OR 97223 DateBy: /
Phone: 503.639.4171 Fax: 503.598. O V Q 200" Q Plan Review
-Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: 1 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF JIGARD Notified/Method: b Supplemental Information
TYPE OF W DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition Forspecial information use checklist
Description Qty. Ea. Total
❑ Addition/alteration/replacement ® Other: LANDSCAPE New 1- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® I -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: 11170 SW EDEN COURT Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: TiGARD, OR 97223
Footing drain (no. linear ft.: Page 2
Suite/bldg./apt. no.: Project name: VANDERSCHOOT Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
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: 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
INSTALL BACKFLOW DEVICE Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: HENS & DONNA VANDERSCHOOT Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: SAME AS ABOVE
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: (503)968-8295 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
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: DENNIS' SEVEN DEES LANDSCAPING, INC. Water piping/DWV 56.29
Address: 7355 SE JOHNSON CREEK BLVD Other: 25.02
City/State/ZIP: PORTLAND, OR 97206 Subtotal
Phone: (503) 777-7777 Fax: (503) 777-2399 Minimum permit fee: $72.50 72.50
CCB Lic.: 5009 Plumbing Lic. no.: 05LIBDI Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20 ✓
Print name: TIFFANY BRIGHT Date: v v 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.
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