Permit CITY OF TIGARD PLUMBING PERMIT
1,1 I . • - COMMUNITY DEVELOPMENT Permit #: PLM2009 -00222
Date Issued: 08/13/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S 13/200 0000
Jurisdiction: TIG
Site address: 15714 SW 81ST AVE
Subdivision: Gage Forest Lot: 7
Project: GAGE FOREST
Project Description: Irrigation backflow.
Owner: FEES
TIMBERLAND HOMES INC Quantity Description Date Amount
12670 SW 68TH AVE
TIGARD, OR 97223 1 ea Beddow Prevention - RES 08/13/2009 $27.55
1 12% State Surcharge - 08/13/2009 $4.35
PHONE: 503 - 737 -9888 Plumbing
9 ea Minimum Fee Adjustment - 08/13/2009 $8.70
Plumbing
Contractor:
REDWOOD LANE NURSERY
8222 BROADACRES RD
WOODBURN, OR 97071
PHONE: 503 -678 -3242
FAX: 503 - 678 -3252
Type of Use: SF
Class of Work: OTR Type of Const:
Occupancy Grp:
Stories:
Total $40.60
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: �W ge� , eel -770 /
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.
• 08- 11 -'09 10:54 FROM- T -146 P003/003 F -094
•
flumpinzPena onRECEIVED
ottazginues 1 1 (,1; (,1 .1 1( 1
City of Tigard AU G 1 Receive DaKBy. d f � 3 / 7 Permit No i d by.2oo 9 -DO,
Illit
13125 SW Hall Blvd., Tigard, OR 97223
■ ' Phone: 503.639.4171 Fax 503.598.1 T IG A RD Plat � � O �, ,M ��Y
I . i , j7 i .�
Inspection Line: 503.639.4175 TY OF Other Permit No
B UILDING DI ON n>u x
Date xeady/By: to See P for
Internet: www.tigard -or.gov NotiSed/Method: 77X..-- Supplemental Information
VISI
TYPE OF WORK . FEE* SCHEDULE
C ew construction ❑ Demolition For special information Ilse checklist
' Description J Qty. I Es. 1 Total
❑ Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
I. - and 2- family dwelling ❑ Connmercial utdustrial SFR (2) bath 350.00
1:1 Accessory building ❑ Multi- family SFR (3) bath 399.00
I=1 Master builder ❑ Outer Each additional bath/kitchen 45.00
Fire sprinkler (_ sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 5- 7/ y is LA) 1 r
�-� Catch basin or area dram 16.60
City /State/ZIP: ?, a( ,, d C5' 7 L23 Drywell, leach line, or trench drain 16.60
Suite/bldgJapt no.: I Project name: Footing drain (no, linear ft.: _) Page 2
Cross street/directions to job site:
a` Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear f1:.: ) Page 2
Storm sewer (no. linear ft: _) Page 2
Subdivision: q ed I Lot `�
Water service (no. linear R: ) Page 2
_ ! �" � `
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
J. - , : / -4- ti. Backwater valve 16.60
0 Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: I i vin b 1 o,....t t V+-e -$ Expansion tank 16.60
Address: I a.. 7o PA) t) (o 4-- 11 3 0 o Fixture/sewer cap 16.60
City /State/LIP: L ,(_ 012- e l 7 1--2.2 Floor drain/floor sink/hub 16.60
Phone: t1/4)3 ) to 2e -Ono Q F ( 3 srtr ft Garbage disposal 16.60
0 APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name:
Ice maker 16.60
Interceptor/grease trap 16.60
Contact name:
Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) `Fax :: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E-mail: _Urinal 16.60
CONTRACTOR Water closet
Business name: 1 16.60
C�u IQA..L Water heater 16.60
Address: ' 4,2.2, ge%Ad .CGYP, ' a Other
City/State/ZIP: () /. / 0R 9 / Subtotal
Minimum rmit fee: S72.50 , Phone: ( ) y... 1,11-1.....- Fax: wr ) p7�''' ‘ L r 7-.-. Residential bacldiow minoimum� Eer Writ fee: $3625 0 G . Z
C :, - ' G , ` , + Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) y 3 V
Authorized signature: '�- '...---t State
PERMIT FEE V0, b e) ✓
Print name: l.or Ai tan _ �„ k, Date • u i aq This permit application expires if a permit is not obtained within
, 180 days after it has been accepted as complete.
*Fee methodology set by Id -County Building Industry Service Board
1:18uiiding tsTr.MU.PermitApp.doc 12?2//0G 440- 46167(10r02/c0MAVEB)