Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 00319
T [G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/05/2010
Parcel: 2S112CC22100
Jurisdiction: Tigard
Site address: 15723 SW 81ST AVE
Subdivision: GAGE FOREST Lot: 28
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 w.. • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No • -tion Center. hose les are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. ou-m33 obtain a copy of the rules
or dir= questions to OUN cal ng 5' .246.6699 or 1.800.332.2344. - 110 A
Iss ed By: OA/ � Permittee Signature: _ - • -
Call 503.639.4175 by 7:00 a.m. for an inspection that bys' ess day.
This permit card shall be kept in a conspicuous place on thajob site completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures usr o
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RECEIVE ro
III �, n' Received . �Gi� 96 O - ezSi/
Cl of Tigard
Date/By: /0 /D ''/- Permit No.:
V 13125 SW Hall Blvd., Tigard, OR 97223 T 5 (U 1p Plan Review
C Phone: 503.639.4171 Fax: 503.598 :1960 DateBy: Other Permit No.:
Inspection Line: 503.639.4175 OF TIGARD Date Ready/By: tu rfs: RI Pa e 2 for
l'IGi�ltp eady y g
Internet: www.tigard-or.gov CITY Notified/Method: Supplemental Information
TYPE OF gdD1�GDIV FEE* SCHEDULE
® New construction ❑Demolition For special information use checklist
Description I Qty. 1 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 ❑ 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: 15723 SW 81"` 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 l Lot no.: 28 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
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Timberland Homes, Inc. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12670 SW 68 Ave #300 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 0 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 I 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 P 1 in WV 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: Lowen Panke y / Date: /D /s // D 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.
I:\Building\Permils\PLMU- PennitApp.doc 10/01/09 440.4616T(10/02/COM/WEB)