Permit W . a CITY OF TIGARD PLUMBING PERMIT
IN
:` ° COMMUNITY DEVELOPMENT Permit #: PLM2010 00280
T ICARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 2S104AD05700
Jurisdiction: TIGARD
Site address: 12884 SW SEVILLA AVE
Subdivision: WALNUT CROSSING Lot: 4
Project: Walnut Crossing
Project Description: Backflow for irrigation.
Owner: FEES
CASA TERRA LLC Quantity Description Date Amount
PO BOX 1082
CLACKAMAS, OR 97015 1 ea Backflow Preventer 08/26/2010 $31.27
PHONE: 1 12% State Surcharge - 08/26/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 08/26/2010 $41.23
Plumbing
Contractor:
4 A LANDSCAPE & IRRIGATION INC
63391 OMER DR
BEND, OR 97701
PHONE: 541 - 419 -3003
FAX: 541- 312 -8793
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.
Issued By: rermlttee Signature: / (` �� Q / /
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.
Aug 2410 12:19p 4A Landscape & Irrigation 5413128793 p.1
Plumbing Permit Application j
Building Fixtures ___ ,
Z , � �, x . 1 1 1 : 'F0 OF IC L 5r o\'iI'.
City of Tigard r-- , , ; S -' Received
13125 SW Hall Blvd., Tigard, OR. ,5 223\ J' Dale/BY i Iii to Perm" 1•1°- Pifir �( .r)9e0
IN
Phone: 503.639.4171 Fax: 503598:1960 A Flan Review I
. ,.i1,1,-
D+ Inspection Line: 503.639.4175 \, A
� � `O
Date/By: other Permit Noy ,�
..� .,. Internet: www.tigard- or.gov P�1� 1 . ` I Date ednidemo •- fin p is � : Supplemental Seeege Information
r t��,J J NOti6edlM /y�y lnformariaa
, t.,j'i ' " °' .. ,
:•• i1�1C�
TYPE OF WORK j FEE* SCHEDULE
[12'IQew construction ❑ 1 *?tilitiati� IFarspecial information use checklist
Description li
❑ Addition/alteration/replacement ❑ Other: New 1.2- firth }{ dwellings [ L Ea. I Total
ngs (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath is r 312.70
81r and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 11 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath I, 50032
❑ Master builder 0 Other:
Each additional l" th/kitchen 25.02
Fire sprinkler ( l sq. ft.) P ane 2
JOB SITE INFORMATION AND LOCATION , Site utilities: 1
Job site address:. 1 y V i J e,..„...._ . _Catch basin or area drain 18.76
� a,i''ri „
City/State/ZIP: '-1 ' Drywall, leach I' e, or trench drain 18.76
Footing drain (no linear $ : ___) Page 2
Suite/bldg./apt. no.: Project name: Manufactured ho a utilities
1, 50.03
Cross street/directions to job site: UOC�1 ket ti....1 T Manholes 18.76
_ Rain drain co or 18.76
Sanitary sewer (no. linear It : :) Page 2
Storm sewer (no. linear ft.: ) Pag 2
t Water service (not linear ft.: _,_) Page 2
Subdivision: 1v1u._ �.lr it� Lot no Fixture or item:11
Tax map /parcel no.: Backflow presenter 1 3127 ' 1 2
DESCRIPTION OF WORK Batitwatervaive i 12.51
4 � /� �,� � �J �. r Clothes washer I 25.02
A i \, \r(; c3r1 ° y� ' Of ` rAck -4 Dishwasher i 25.02
Drinking fountain 25.02
Ejectors/sump I 25.02
.B PROPERTY OWNER• ❑ TENANT Expansion tank ( 12.51
Name: ' eta I l`7C� VI 42.4S Fixturefsewet cap; 25 -02
Address:
Floor drain/floor s�rik/hub 25.02
Garbage disposal ; I 25.02
City/StateJZIP: Hose bib I 25.02
Phone: ( ) Fax: ( ) Ice maker
12.51
4ErAPPL1CANT ❑ CONTACT PERSON Interceptor/grease i imp 25.02
Business name: [r T L&h� 4 Cl y M N edical gas (value[ S ) . Page 2
Contact name ijarr Lir,� �" prime T' I 12.51
�� ` � r y Roof drain (commercial) 1231
Address: c;( f � • . A ��_ ! Sink/basin/lavatory 25.02
City /StatelZlP:
ql - t n ] Solar units (potabld water) 62.54
Phone: ( ) .tea Fax: : ( ) a a _ = ` Tub /showerfshowei pan 1151
E-mail: Urinal I 25.02
\I �, • • 1 ' a g iI • II V Water closet ii
CONTRACT 1 R 1 I 25.02
Water heater ``,,��1 37.52
Business name: 1Q. � e chit` -Q Water piping/D 56.29
Address: Other
11 25.02
CityIStatz/ZIP: I I Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: 57230 7).51)
I ,.C.[� I I Plan review (25 %ofpermit fee)
CCB Lic.: +$ZZ-� y / 5 ` � lwnbin g Lic. no.: 1 State surcharge (12% of permit fee) T",
Authorized signature: �7c� TOTAL PERMIT FEE
Punt name: • �' rte. k.i�5ak Date: $, Z F/� i) This permit applicapon expires if !l is not obtained whirs 018 da s
J fifer it has bees ccepted as com plete
"Pee methodology set by Tri- County Budding Industry Service .
Lr&,itdirieParnits1PLMU -Pe mnAppdor Iorotro9 44 0- e6161(149721conv VEB)
■