Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00259
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/09/2010
Parcel: 2S102CC04100
Jurisdiction: Tigard
Site address: 13695 SW CRESMER DR
Subdivision: Lot: 0
Project: Kouzes
Project Description: Backflow preventer for irrigation.
Owner: FEES
KOUZES, ROSS T & Quantity Description Date Amount
KOUZES, LISA A, 13695 SW CRESMER DR
TIGARD, OR 97223 1 ea Backflow Preventer 08/09/2010 $31.27
1 12% State Surcharge - 08/09/2010 $8.70
PHONE: Plumbing
41 ea Minimum Fee Adjustment - 08/09/2010 $41.23
Contractor: Plumbing
BEAVERTON PLUMBING INC
13980 SW TV HWY
BEAVERTON, OR 97005
PHONE: 503 - 643 -7619
FAX: 503 - 643 -7620
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 1.800.33 .
Issued By: Permittee Signature: / l
Ca Ca 1.4175 by 7:00 a.m. for an inspection that business day.
. P Y
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.
Rug 06 2010 8:36RM BEAVERTON P U H NG INC. 5036437620 page 1
Plumbing Permit Application '' ' , \
Building Fixtures `;- � ti�
101: ltlII1 1 1 ,1. u�l
City of Tigard � v,\§.1. , � �'�. Received -.s.
13125 SW Hall Blvd., Tigard, OR 97223 ' � ° Dew �� a/ ,/ �.
Phone: 503.639.4171 Fax, 503.598.1960 ' '∎ Plea Review "
II I I II
I>ate/By. Other Perarit No.: • J "
Inspection Line: 503.639.4175 C )t)//) - f i n " r
Internet: www tigard -or gov Date R°8d 1a�,s /
i ' F w E k F z r �iYT.t St See , ., for f t : .
r ! # E , � atsi , r : F r ADo�ed/Metbod r Stu MI Information iY°a2��JE2 �I • �' •, }t�.V�'� +(�'c/1f1.i:vLiL'S.u,l.r_,i. i i1 � E,. L L ... .
❑ New construction u Lion ❑ Demolition µ � 4 V ~ For special Infoswuttion use theatist
® Addition/alteration/replacement Other- Description 1 Qty. 1 Ea. 1 Total
•�5�; a att i ti J: / a a at � re y , c c i New 1- 2-fa . dwellln.. includes 100 8 for each u •
' ^i l` ,n't n R . ,< ie• 2' ,,- ] y{ 4 •h ,, '",- 1 ' �t 2.r. 1 }r^ a ' i v 4
t ^ :.v.�Ji>:'� •':�azr ..r..,` .saraic a ..0, S. .0 ' S i . 3n, " ..., - -, r N „i' � SFR (1) bath 312.70 t
® 1- and 2- family dwelling ❑ Commercial/mdustrial SFR (2) bash 437.78
q
❑ Accessory building ID Multi-family SFR (3) bath 500.32
Each additional bath/kitchen itchen
El Master builder ❑ Off. 25.02
Fire nlcler
, t + -4 µ lux '', : w ;� . rc w , s x� ∎�•4Pi ti Z.� f.V. ih / Fir
i L__ sQ.$) Paget
4
•
�f '''1? f
U. i x:i .e.i 3 m r,✓r ._ �:,�es;i r. ". . F} y 81 a utitltles:
Cs.+.�2�,a.::t'.:..'.iu ... . #_wcaa?111`...,c:
Job site address: 13695 SW CRESMER CRT Catch basin or area drain 18.76 i
City/State/ZIP: TIGARD, OR 97223
Drywall, leach line, or trench drain 18
Suite/bldg./apt. no.: J Project name: - Footing drain (no linear fl.: ) Page 2 . •
Manufactured home utilities 50.03 '' R
Cross street/directions to job site: Manholes
18.76
Rain drain connector 18.76 ,
Sanitary sewer (no. linear ft.: ,) Page 2
Sloan sewer (no. linear IL: _) P age 2
Water service (no. linear ft,: _) Page 2 t Lot rto.. -
Subdivision
T Fixture or item: ax l M.: BackHow preventer 1
t r >v �,�{ rrJ. pr k . 31.27 31.27
+,•y4;' Lt+ Y , G ftl e, �. {rh 1.�t u `}. t
.i.�.,cY Lt.:.t= y , t_ �t clothes .51
� 3�::.�.vL:. � :i.G,f:L� a.,._., • IAVWeti washer
INSTALL NEW DOUBLE CHECK 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02 ," ' '
••. ✓uIi?,. i S e ! � 8 I j A i Yt tl 1 , � ��� � ,� ° J � , �.� Yi 7 � ' +t ! -d •
.t .. w :.- ._...- ...,c�.�.a:_w.,d, . .L.+•.+ -^` - +r fa ..,..... l _. 1 .1 ,s t .. .,.._ I1 . - ... l; 12.51
Name: ROSS KOUZES
Fixture!' sewer cap 25.02
Address 13695 SW CRESMER CRT Floor drain/floor sink/hub 25.02 _
Garbage disposal 25.02 ' IN City /State /DR TIGARD, OR 97223 Hose bb 25.02 • i ';t
Phone: (503)887-5533 Fine ( )
� i` r •�4 � < _; Ix �.liar�s _ .
le er 12.51
1
�. tJS Vie. tea. X of . ut: r e rte• : 1 y . intereePtoriPease trap 25.02
Business name: Medical gas (value: 3 ) Page 2 ; .:
Contact name: Primer 12.51
Address - Roof drain (commercial) 12.51
Sioldbasin/lavatory 25.02 .
City/State/ZIP: `2
Solar units (potable water) ) ; i
Phone: ( ) l Fax: : ( ) Tub/shower /shower pan 12.51 r' 6,
E-mail: Urinal 25.02 ; - r
y�`l s ' � LC. S . • t �.+Sy'^' -7- 9Qi. {, .w y, itY: ti & ,�,?ei t _Ml.' . {t ;1;4,, ,•,,:i ix s ,1 .- J , W aterc klset 25
;!¢ .451�3s..,::. ! SL, F . ..i1�.Yt 461:k I b� � r , 5 a ',2-
Lm, t a 'ra ti_'-, Water heater
Business name: BEAVERTON PLUMBING, INC. 37.52 '
Water piping/DWV � ` i
Address: 13980 SW TUALATIN VALLEY HWY 25.02
Other. 25.02 At,
City/State/ZIP: BEAVERTON, OR 97005 Subtotal , �s. ?'
Phone: (503) 643 -7619 Fax: (503) 643 -7620 Minimum permit &e: $72.50 72.50 i
CCB Lic.: 12889 lambing Lic. no.: 34-4PB Plan review (25% of permit fee)
Authorized signature : ' State surcharge (12% of pelatit fee) 8.70 '' `
TOTAL PERMIT FEE
Print name: COLLEEN KN1GHTON This r a . '
Date: 8/6/ /2010 p� ppli adoa gaudier if p atient i s no obtained within 18?flsyt
after it has been accorded at complete.
*Fee methodology set by Tri- County Building Industry Service Boynt
I: \BuildiiglPamR2PLMU-Per stMPdce 10/01/09 4404616T(10/02/COM/WEB)