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Permit
q CITY OF TIGARD PLUMBING PERMIT .11 111 COMMUNITY DEVELOPMENT Permit #: PLM2010 00318 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/05/2010 Parcel: 2S112CC20800 Jurisdiction: Tigard Site address: 15602 SW 81ST AVE Subdivision: GAGE FOREST Lot: 15 Project: Gage Forest Project Description: Installation of residential backflow preventer for irrigation. Owner: FEES TIMBERLAND HOMES INC Quantity Description Date Amount 12670 SW 68TH AVE TIGARD, OR 97223 1 ea Backflow Preventer 10/05/2010 $31.27 PHONE: 503-620-8860 1 12% State Surcharge - 10/05/2010 $8.70 Plumbing 41 ea Minimum Fee Adjustment - 10/05/2010 $41.23 Contractor: Plumbing REDWOOD LANE NURSERY 8222 BROADACRES RD WOODBURN, OR 97071 PHONE: 503 - 678 -3242 FAX: 503- 678 -3252 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 Not .: ' • - . - Those = - are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or dir• questions to OUN • .Ilin• 503.246.6699 or 1.800.332.2344. Iss ed 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. Plumbing Permit Applicati C i \ H � -_r / ° -- COO l Building Fixtures 5 V` rolz orrlci: t si o:Ni.' City of Tigard 0:-:\ ,�1G p,R 0 j y Date/By: Received d©Ar �� Permit No.: itHAO 60.31i q 13125 SW Hall Blvd., Tigard, OR 97223 ,�.� F 1 • C ❑hone: 503.639.4171 Fax: 503.598.11: l l ' / �lv1S Plan Review Other Permit No.: , �G Date/By: I G A R D Inspection Line: 503.639.4175 Bv1L Date Ready/By: luris: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental lnformation TYPE OF WORK FEE* SCHEDULE ® New construction ❑ Demolition For special information use checklist Description 1 Qty. I Ea. 1 Total ❑ 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 ❑ Commerciallindustrial 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: 15602 SW sr st 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.: I Project name: Gage Forest Manufactured home utilities 50.03 Cross street/directions to job site: Langtree 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: Gage Forest I Lot no.: 15 Fixture or item: Tax map /parcel no.: Backflow preventer 1 31.27 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Backflow Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Timberland Homes, Inc. Fixture/sewer cap 25.02 Address: 12670 SW 68 Ave #300 Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: Tigard, OR 97223 Hose bib 25.02 Phone: (503)620 -8860 Fax: (503)598 -9081 Ice maker 12.51 ❑ APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02 Business name: Timberland Homes, Inc. Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Steve Brown Roof drain (commercial) 12.51 Address: 12670 SW 68 Ave, #300 Sink/basin/lavatory 25.02 City/State/ZIP: Tigard, OR 97223 Solar units (potable water) 62.54 Phone: (503) 620 -8860 Fax: : (503) 598 -9081 Tub /shower /shower pan 12.51 E -mail: info @timberlandhomes.net Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: Redwood Lane Nursery Water piping/DWV 56.29 Address: 8222 Broadacres Rd NE Other: 25.02 City/State/ZIP: Woodburn, OR 97101 Subtotal Phone: (503) 678 -3242 Fax: (503) 678 -3252 Minimum permit fee: $72.50 72.50 CCB Lic.: LCB 7009 Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) 8.70 Authorized signature: TOTAL PERMIT FEE 81.20 Print name: Lowed Panke Date: �/��JJ�� This permit application expires if a permit is not obtained within 1S0 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1:\ Building \Permits\PLM1J-PennitApp.doc 10 /01/09 440- 4616T(10/02/COM/WEB)