Permit CITY OF TIGARD PLUMBING PERMIT
IV ' DEVELOPMENT Permit #: PLM2010 -00347
T I G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2010
Parcel: 1 S135CA09400
Jurisdiction: Tigard
Site address: 11464 SW 96TH AVE
Subdivision: SOLERA Lot: 3
Project: Solera
Project Description: Backflow for irrigation.
Owner: FEES
GREENBURG TERRACE LLC Quantity Description Date Amount
735 SW 158TH AVE #180
BEAVERTON, OR 97005 1 ea Backflow Preventer 10/22/2010 $31.27
PHONE: 503-332-7167 1 12% State Surcharge - 10/22/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 10/22/2010 $41.23
Contractor: Plumbing
TRADEMARK LANDSCAPES INC
P. O. BOX 2410
OREGON CITY, OR 97006
PHONE: 503 -631 -3893
FAX: 503 -631 -4737
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: Permittee Signature:
�J
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 Application
Building Fixtures FOR CI is ii 1_ z o USE oNIA
q 1Q Received _ City of Tigard Sk eaCkeoN
Dace.By^ 0 ‘ / 0 6T>- Pertoit No.: P! /Y� I ` c)03 7
1111 Q + 13125 SW Hall Bhrd., Tigard, OR 972 B p � Plan Review
N 'o " V
■ Pholle: 503.639.4171 Fax: 503.598.1960 C t� t _ I1ateB): Other Permit No.: M 57' Lt)03�(
Inspection Line: 503.639.4175 e I`GP� N bt a ReadyBy; Boris: El See Page 2 for
I i c; Al:. l) n � ` S_ � 1 Internet: w
Wa.tigard er.gov , l i f iedlMei}ud: I Suppie eatal Informalioa
• TYPE OF WORK B O .- �NG O ` v I FEE' SCHEDULE
Ea ❑ Demolition For spaded information use checklist
New construction Description } QIy. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 300 ft. for each utility connection)
. CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
SFR (2) bath • 437.78
ql 1 -and 2- family dwelling ❑ Commercial industrial t SFR (3) bath 50032
D Accessory building ❑ Multi-family Each additional bath/kitchen 25.02
❑ Master builder 0 Other: _ Fire sprinkler (__sq. R) j Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
t Catch basin or area drain ! 18.76
Job site address: \ k Lii,14 S 1U) " Drywell, leach live, or trench drain 18.76
City /State/ZIP: 1 % . t r \ Cj V. . Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: ' Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
4 v-.., n k1 4 Y g 'y S lrR - a' V.. 1 Sanitary sewer (no. linear ft.: ___) Page 2
Storm sewer (na linear f.: _) Page 2
Water service (no. linear ft.: _j Page 2
Subdivision: 5 0 Lot no.::. 3 Fixture or item:
fax map/parcel rto : Backilow prcventcr 3127 1
Backwater valve 12.51
DESCRIPTION OF WORK Clothes washy 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/surop 25.02
lit PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
} -. ll'' Fixturdsewa cap 25.02 •
Name: L ` c „ it \ , s r S Floor drain/floor sink /hub 25.02
Address: - 13 S S 1, J . \C, % p f . j„4,.. \ $t Garbage disposal 25.02
City /State/ZIP: 1 -) o e...v , r k9 y. fl '‘). i.`.'{ F t (, Hose bib 23.02
Phone: (S 6 6 7 S 0 ^ 7c Fa): (5 0 3 1 I., - 1 1tit Ice maker 1231
-
❑ APPLICANT ❑ CON'TACr PERSON 1oterceptorlgrease trap 25.02
Medical gas (value: $ ) Page 2
Business name: Prima 1231
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /StateIZIP• Solar units (potable water) 62.54 :
Phone: ( ) 1 Fax:: ( ) Tub/shower /shower pan 12.51
Urinal 25.02
E -mail: Water closet 25.02
CONTRACTOR Water heats 37.52
Businessnamc: /tA10E171 07 (4lIUCISt,/9 -#s. 2 tC. Waterpiping/DWY I 56.29 r
Address: A Other 25.02
-
City/State/ZIP: jJ,- ,.(ale, tJ]
t - 7 71Y.F Subtotal
Minimum permit fee: S72.50 - 7,)_ ,5-
(, ) U31✓✓ ' - 3893 _ Fax: (,03) Z y ?37 Plan review (25% of permit fee)
CCB Lia: jib - G c Plumbing Lie. no.: - State surcharge (12% ofpeemit fee) r :^
Authorized signs TOTAL PERMIT FEE }
This Pamir appllcatiou expires if a permit is net obtained within 180 do a
Print name: r f �l I Date: �(�� JzOJ� after it has been accepted es complete.
*Fee methodology set by Tri-County Budding Indust~y Service Board.
1: 01 LItrtreartitiftitttYPenulappAoe IOteli09 44G46t6T(10102/COMN'e) 4 3 . Loo
•
v L£LtrL£9-£05 spue1)IJBWOpeJl d6S:90 0 L LZ PO