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Permit CITY OF TIGARD PLUMBING PERMIT ' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00028 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2011 Parcel: 2S108AB05000 Jurisdiction: TIGARD Site address: 14051 SW 155TH TER Project: Brentwood Estates, Lot 12 Subdivision: BRENTWOOD ESTATES Lot: 12 Project Description: Residential backflow device. Contractor: TRADEMARK LANDSCAPES INC Owner: WEST HILLS DEVELOPMENT P. O. BOX 2410 735 SW 158TH AVE. OREGON CITY, OR 97006 BEAVERTON, OR 97006 PHONE: 503 - 641 -7342 HONE: 503 - 631 -3893 FAX: 503 - 631 -4737 FEES Quantity Description Date Amount 1 ea Backflow Preventer 01/26/2011 $31.27 Specifics: 1 12% State Surcharge - 01/26/2011 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment - 01/26/2011 $41.23 Class of Work: OTR Plumbing 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 -0090. You may obtain a copy of the rules or direct q stions to OUNC. by calling 13.232.1987 or 1.800.332.2344. Issued f\ / `/ ' , / Permittee Signature rN /,Jn Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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 Applicat ion pg � p , p, / 9 Building Fixtures row orrice Use ONLY': . � m,�p, City of Tigard JAN 2 6 2011 Received /7e:;24/;/ -- Pcnn"Na.�l 0 Gr/Ot24 s3 q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revin 11 Phone: 503.639.4171 Fax: 503.5984960 P Date/Br Other Permit Naha. // OOO� Inspection Line: 503.639,4175 till I v OF I R.:-Liz, 30' Date RcadylDy. runs: ® See Page I tar T1G n1l D Internet: twwtv.tigard- or.gov BUILDING DIVISION __ f i NoliGcdlMcthad: Supplemental information 441.'.5. .� " , 0 , t m .. , a v, -,.. . 'e w ". t 1 ' , ar .. i `°� . s , _- . s ' - , t D For special lufonnallautrse checklist ® New construction Description I Qty. I En. I Total ❑ Addition/alteration/replacement 0 Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) " c Ili of {. o - 3e, o W''T to SFR (I) bath 312.70 © 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath 50032 0 Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Page 2 ` 4 "40 t f i T a l P r e WWI _ O G J H O Rille,F40 Site utilities: Catch basin or area drain 18.76 Job site address: 14051 SW 155th Terrace Drywcll, leach line, or trench drain 18.76 City /State/ZIP: Tigard OR 97224 Footing drain (no. linear It.: ) Page 2 Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no: linear ii.: _I Page 2 Storm sewer (no. linear R-: ) Page 2 Water service (no. linear IL: ) Page 2 Subdivision: Brentwood Estates I Lot no.: 12 Fixture or Item: Buckllow preventer I 31.27 Tax map /parcel no.: ,�- .,.�.. �, .�, , a° , , Backwater valve 12.51 it , �i(4�rr;=�'77kr DE �f11 OAT/' ' *.' ; € °:'ir 3. :�'� .,,s r�,� : Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 Y tri R a * p o tORMIrfri , - ' " Ez ansion tank 12.51 Fixture/sewer cap 25.02 Name: West Hills Development Floor drain/floor sink/hub 25.02 Address: 735 SW 158 Ave Garbage disposal 25.02 City /State/ZIP: Beaverton OR 97006 Hose bib 25.02 Phone: (503)641 -7342 Fax: (503)641 -7661 Ice maker 12.51 r'1P G t e/ Pt 1 •q " tt 'ill �;P..--„� O 1a tercel/ tor /grease trap , 25.02 Business name: West Hills Development Medical gas (value: _ ) Page 2 Primer 12.51 Contact name: Angie Cook Roof drain (commercial) 12.51 Address: 735 SW 158 Ave. , Sink/basin/lavatory 25.02 City /State/ZIP: Beaverton OR 9700'6 Solar units (potable water) 62.54 Phone: (503) 641 -7342 Fax: : (503) 641 -7661 Tub /shower /shower pan 12.51 Urinal 225.02 E-mail: acoel@a nrborhames,com ,.";, r , , ',, � O ' :,r° rs "' g, Water close[ 25.02 ,�' Es:..� .. ". '� Water heater 37.52 Business name: Trademark Landscape Water plping/DWV 56.29 Address: 19088 S. Redland Rd. Other. 25.02 City /State/ZIP: Oregon City, OR 97045 Subtotal Phone: (503) 631 -3893 Fax: (503) 631 - 473? Minimum permit fee: $72.50 r f3 / d f Plan review (25% of permit fee) CCB Lie.: 11353 i no.: 6 / (12% 9H State surcharge (12 of permit fee) Authorized signature: �� TOTAL PERMIT FEE pi. �v D a le: This permit application expires If n permit R not obtained within 180 days Print name: Steve Ellis 1/27/ 1 1 after ii has been accepted ns complete. "Fee methodology set by Tri- County Building Industry Service Board. I. tauild lnUWenuitstPLMU- PermhApp.doe IWalros 44a- 1616T(la+a1CoM/wEsi)