Permit Y a CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit #: PLM2010 -00251
mss; Date Issued: 07/30/2010
[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S133DB02300
Jurisdiction: Tigard
Site address: 11591 SW 134TH PL
Subdivision: BRITTANY SQUARE NO. 2 Lot: 47
Project: Wasco
Project Description: Installation of residential backflow preventer for irrigation.
Owner: FEES
WASCO, TERI V Quantity Description Date Amount
11591 SW 134TH PL
TIGARD, OR 97223 1 ea Backflow Preventer 07/30/2010 $31.27
PHONE: 503-579-9727 1 12% State Surcharge - 07/30/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 07/30/2010 $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
Utif 'o ification e Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
direct questions to OUN alli . 50 .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.
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Plumbin2 Permit Applicatio + ECEIVED
Building Fixtures JUL. I OR of Flc i B UST ONLv , .
JU 3 0 ? g
- City of Tigard Received V
Date /By: 7 JO /O Permit No.: i t 1.490/0 - co 95/
e 13125 SW Hall Blvd., Tigard, OR C44 OF TIGARD Plan Review
il
II '• Phone: 503.639.4171 Fax: 50 Date /By: Other Permit No.:
Inspection Line: 503.639.4175 ��ILI DIVISION
I I G`A R D' p Date Ready /By: Juris: 0 See Page 2 for
Internet: www.tigard or.gov Notified /Method: Supplemental Information
TYPE OF WORK FEE* SCHFDUI;E
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. Ea. I Total
t. 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
' dOB SITE INFORMATION AND LOCATION. Site utilities:
Job site address: ) \ 1 ' 5 W \ 's I- P Catch basin or area drain 18.76
'�� 0‘,-111-`7.-3 Drywell, leach line, or trench drain - 18.76_
City/State/ZIP: ` ' �t'r - Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt. no.: I Project name: 1,0 ( D 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
Stonn 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 31.27
DESCRIPTION OF WORK Backwater valve 12.51
i s - Clothes washer 25.02
/ kk ■IlC. J \ C- ' Z Z \ OkA Dishwasher 25.02
D CA ) a c Drinking fountain 25.02
Ejectors /sump 25.02
- 6" PROPERTY OWNER.. . I - : ❑ TENANT. Expansion tank 12.51
Name: t `\ Fixture /sewer cap 25
�f 1 `� r.:-,,, .- r, Floor drain /floor sink /hub 25.02
Address: N. v Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: (tjoff) S- ,., q' 27) Fax: ( ) Ice maker 12.51
APPLICANT ., : P°!' ERSON ,- Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name:
�� -SS J'i Primer 12.51
• Contact name: - ` O ,.,.\ ( L` - , e rA �'t
Roof drain (commercial) 12.51
Address: ZC � G Cv Ne,, \ - N \ t Sink/basin /lavatory 25.02
W
City /State /ZIP: A U 1, C. ® p � C 7 0 Solar units (potable water) 62.54
Phone: (5 ) (: _ h 0-7 b Fax: : (6 ) c! _ u k c -? 5 Tub /shower /shower pan 12.51
Urinal 25.02
E -mail: CTb \Iv.e. Q.- Q1-0 r-t�S � C-c5
- - - -- r . - - - Water closet 25.02
• CONTRACR • ' Water heater 37.52
Business name: Yr ( .. - i pC 4 Water piping/DWV 56.29
Address: C '' 0=^ C- Other: 25.02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum pennit fee: $72.50
CCB Lic.: O 7 C` Plumbing Lic. no.: Plan review (25% of permit fee)
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State surcharge (12% of pennit fee)
Authorized signature �L, \ TOTAL PERMIT FEE �1
Print name: " J Date: - , This permit application expires if a permit is not obtained within 180 days
r - p - t 1 e_ after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I \ Permits \PLMU- PennitApp.doc 10 /09 440- 4616T( I 0 :02 /COM /WEB)