Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00346
T I GAR L) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2010
Parcel: 1S135CA09300
Jurisdiction: Tigard
Site address: 11476 SW 96TH AVE
Subdivision: SCLERA Lot: 2
Project: Solera
Project Description: Backflow for irrigation.
Owner: FEES
GREENBURG TERRACE LLC Qua ntity Description Date Amount
735 SW 158TH AVE #180
BEAVERTON, OR 97006 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
Plumbing
Contractor:
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.
111111 Issued By: Permittee Signature: 4 6 - 1 ., _
CaII 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 l'OR QI FiCG l sE o�'i_�
Received
2 10 D : �►
II 13125 SW Nall Blvd., Tigard, OR 97223 , 1 2 2 P lan Rc�ietr OthorPermiiN/1.: MSrev JD'uue `t4 1 Phone: 503.639.4171 Fatc: SD3.598.1960 tbtelBy:
- inspection Line: 503.639.4175 �G t • • 1, fiedMethod:
[cadre.. Jura: El See PPop 2 for
l 1 : :� t) intern= wvrw.tigard -orgov art , 1 G FEE' SCHEDULE E':: , Supplemental Information
. F or te ► � OF WORK �� radon nee checklist
R' Ne.+ construction 1 ❑ Demolition Description 1 Qty 1 Ea. 1 Total
❑ Addition/alteration/replacement 1 ❑ Other. New 1 -2- family dwellings (includes 100 IL for each utility connection)
SFR(q bath I 312.70
CATEGORY OF CONSTRUCTION SFR
(I) bath II 437.78
t.1 -and 2- family dwelling ❑ Cornmercial#ndustrial SFR (3) barb 500.32
❑ Accessory building ❑ Multi- family Each additional batlukitcheo 25.02
❑ blaster builder ❑ Other: Fire sprinkler ( sq. 1.) Page 2 ,
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: \ t 1..1'1 C GI ‘ s‘ Drywef, teach line, or trench drain 18.76
City /StatelZIP: 'AT .v. .rr�• CJ Footing drain (no. linear ft.: _J . Page 2
Suite/bldg. /apt. no.: i I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
S f t train drain connector ? , �� c t Jl C .r,. - �c, : (: �• .l Sanitary sewer (no. linear h.: _J Page 2
Storm sewer (no. linear ft.: ... J Page 2
Water service (no. linear ft.: „) Page 2
Subdivision: 5 I Lot no.: Fixture or item: r - -- -
e : r ` Backfloa premier '
i 31.27 1 l
Tax map/parcel no.: Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
pa
PROPERTY OWNER I ❑ TENS Expansion tank 12.51
Fixturdsewer cap 25.02 1
Name: v e .r t }I- L,. R5 Floor drain/floor sink/hub 25.02
Address: S S 5_Uil \ S V-= A vC. S ...`e), ? 1 2,6 _ Garbage disposal 25.02 •
City /State/ZIP: 1, err.12 t -t,v, CA... CA It) ii Hose bib
25.02
Phone: (spy; ) Z 5C3 - `� Fax Fax (0-s) '('. -ti - i It iou
maker ig reas a trap
23 .02
❑ APPLICANT ❑ CONTACT PERSON
Medical gas (value: S ) Page 2
Business name: Prime 12.51
Contact name•. Roof drain (commercial) 1231
Address: Sink basinllavatory 25
Solar units (potable water) 62.54
City/State/ZIP: 12.51
Phone: ( ) I Fax:: ( ) Tub /shower /shower pm
Urinal 25.02
E -mail: Water closet 25.02
CONTRACTOR Water heats 37.52
Business name: ) f,q€ �..c.Gts C-/.'f, .- i1.4.- Water pipinglDWV 56.29 446 a V Other: 25.02
Address: Subtotal
City/State/ZIP: 4. - . p � ', �J 4 Minimum permit fee: 572.50 76), co Phtxte (�� !Q 36-74(p 0 3 F ax: ( �+G(J 6,f/ �93//� ! P review (25% of permit fee)
cm Lic.: „ Plumbing Lic. no.: State surcharge (12 °k of permit f e) g- 7D ,
• Authorized Bu �*_ / `, TOTAL PERMIT FEE g ) , eo
/ I Date: rbia permit application aspires if a permit is of obtained %rid& 180 days
• after It has been accepted as s complete.
i Print name: //l
'Pee methodology see by Tri -County Building Washy Service Board.
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£'d L£Lv-L£9 -£05 spuB1 Jewepe1l, d69:90 0i. 2100