Permit v CITY OF TIGARD PLUMBING PERMIT
111 o COMMUNITY DEVELOPMENT Permit #: PLM2010 00355
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/28/2010
Parcel: 1S125DC09300
Jurisdiction: Tigard
Site address: 7272 SW SHADY PL
Subdivision: ASH CREEK ESTATES Lot: 26
Project: McBride
Project Description: Backflow for irrigation.
Owner: FEES
ASH CREEK PROPERTIES LLC Quantity Description Date Amount
12655 SW NORTH DAKOTA ST
TIGARD, OR 97223 1 ea Backflow Preventer 10/28/2010 $31.27
PHONE: 1 12% State Surcharge - 10/28/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 10/28/2010 $41.23
Contractor: Plumbing
CASCADIAN LANDSCAPERS, INC.
21510 NW FARM PARK DR.
HILLSBORO, OR 97124
PHONE: 503 - 647 -9933
FAX: 503 - 647 -9922
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:
40/° cG
all 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 RECEIVE ,_
Site Utilities OCT 28 2010 i of orrlcl t si ()Nu
City of Tigard R eceived g Permit No.: /JL Ol U - 00 - 35s
13125 SW Hall Blvd., Tigard, OR 97223
Date/By: Re �(� / V
C
•
Ph 503.639.4171 Fax: 503.598.1 ITY OF TIGARD Plan Review Other Permit No.:
Inspection Line: 503.639.4175 6f ILDING DIVISION Date/BY M.STSU1t) vol�t3
TIGARD Date e ReadyBy: l ur i s: El S ee Page 2 for
Internet: www.tigard - or.gov Notified/Method: 1 ) Supplemental lnformation
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description 1 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 ❑ 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: 7272 SW Shady Place Catch basin or area drain 18.76
City/State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: McBride Residence Manufactured home utilities 50.03
Cross street/directions to job site: SW Taylors Ferrys Road and 74 Avenue 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: 1 Lot no.: 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: Matt McBride Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 7272 SW Shady Place
Garbage disposal 25.02
City/State /ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: Cascadian Landscapers, Inc. Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Arthur Meisner
Roof drain (commercial) 12.51
Address: 21510 NW Farm Park Drive Sink/basin/lavatory 25.02
City/State /ZIP: Hillsboro, OR 97124 Solar units (potable water) 62.54
Phone: (503) 647 -9933 Fax: : (503) 647 -9922 Tub /shower /shower pan 12.51
E -mail: art@cascadianlandscapers.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Cascadian Landscapers, Inc. Water piping/DWV 56.29
Address: 21510 NW Farm Park Drive Other: 25.02
City/State /ZIP: Hillsboro, OR 97124 Subtotal 31.27
Phone: (503) 647 -9933 Fax: (503) 647 -9922 Minimum permit fee: $72.50 72.50
Plan review (25% of permit fee)
CCB Lic.: 51443 jj1,/, Plumbing Lic. no.: LCB #5185 7/3t/�/ State surcharge (12% of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
Print name: Arthur Meisner Date: 10 -26 -10 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 Building Industry Service Board.
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