Permit q CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00096
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2011
Parcel: 2S103CC15400
Jurisdiction: Tigard
Site address: 12275 SW PLANTATION TER
Project: Stepping Stone Estates lot 4 Subdivision: STEPPING STONE ESTATES Lot: 4
Project Description: Install residential backflow preventer for irrigation system.
Contractor: FOREST LANDSCAPE INC Owner: ALDER HOMES LLC
3975 NW SUSBAUER RD PO BOX 2189
CORNELIUS, OR 97113 BEAVERTON, OR 97075
PHONE: 503 - 648 -8308 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/29/2011 $31.27
Specifics: 1 12% State Surcharge - 03/29/2011 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 03/29/2011 $41.23
Plumbing
Class of Work: OTR
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 • - stions to OU • •y calling 503.232.1987 or 1.800.332.2344.
Issued :y: i e Permitte ignature: , 4L-/
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 Annlication
Site Utilities // IOR 01FIC£ l5F ON1.t
City of Tigard may, a fr / Permit No.: � / ay/ _4.011 ci;16,
+n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
r ; , , t 1: i
Inspection Line: 501639.4175 Date 4/8y: runs: B see Faye 2 for
Internet: Nwvw_tlgard- or.gov Notitied/Mcthod: , Suppleaonmt Information
TYPE PE OF WORK. FEE* SCHEDULE
❑ New construction ❑ Demolition For special ix /ofm oie use checklist
l
- Description 1 Qty, I Pa.. . Total
El Addition /alteration/repIacement ❑ Other: New 1- 2.femily dwellings (includes 100 it, for each utility connection) .
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
'® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) both 437.78
❑ Accessory building 0 Multi - fatuity SFR (3) bath - 500.32
Each additional bath/kitchen 25.02
0 Master builder ❑ Other: Fire sprinkler ( sq. ft.) - Pap 2
JOB SITE INFORMATION AND LOCATION Site utilities:
d .- Catch basin or area drain 18.76
Job sttc address: 12 ' k.) \ G Hv C 4 1 c . I: X Drywall. leach Zinc, or wench drain 18.76 .
City / State/ZIP: 1' rd • _ _ w_
Footing drain (no. linear R.: -,_,) Page 2 _ _
Suite /hldg. /apt. no.; Project name: Manufactured home utilities 50.03
Cross street/directions to job site: - µ Manholes 1836
Rain drain connector 18.76
Sanitary newer (no. linear ft: _J Page 2 .
Storm sewer (no. linear ft.: ) Page 2
Water service (no- linear 8.: ..) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: BackfloW preventer I 31.27 31. Z 3
DESCRIPTION OF WORK Backwatervaive _ 12,51
Clothes washer 25.02
Z-f _iii a I 1 1rrii - x-i'i C V 1 1 7' ciri -- 1 Dishwasher w 25.02
�J / Drinking fountain 25.02
Ejectors/sump 25.02
1>1 PROPERTY OWNER ❑ TENANT E iansion tank 12.51
- Fixture/sewer cap 25.02
Name: Ma ■ (. . AA " . l or drain/floor sink/hub - 25.02
Address: Garbage disposal - 25.02
City /State/ZIP: Hose bib 25.02 _ _
Phone: ( ) Fax: ( ) Ice maker
_ 12.51
❑ APPLICANT '® CONTACT PERSON interceptor /grease trap 25.02
Business narr►e: - Medical gas (value: $ T ) Page 2 -�
. #.l_& . .. • .* ♦ Primer 12.51
Contact name: Oar `n[ .. Roof drain (commercial) 12,51
Address: Gl k j , A. 1 Sink/basin/lavatory 25.02 ' ,
City /State/ZIP: •' L i '1 M Solar units (potable water) 62.54
Phone: ( r• ! Fax :: Tub /shower /shower pan , , 12.51
E-mail: Urinal 25.02
Water closet 25,02
CONTRACTOR Water heater 37.52
Busincssname: > ,r�+ d C =W Water piping/DWV 56,29
Address: ,39 7' N`A i, ,5( V
_:. A � Rd Other: 25.02
City /State/ZIP: C(�Y D 1 Lk j Z C19 /J3 Subtotal i. Z
Phone: &,x cp ti _ f ' O pax- ) ( vt F _ - Minimum permit fee: $72.50
D -Lie.: t e.1 Plumbing I ic. no.: ..,_, „,_ plan review (25% of permit fee)
�' •`� � -.- State surcharge (12% of permit fee) , . c.)
Authorized signature: I r / TOTAL PE n RMIT FEE i 1 '
t � nit permit application expires if a permit is not obtained Within day
Print name: 4. -• , • • •u ,. �� a Da te: G i after it bas beau accepted ors complete
*Fee methodology set by Tri- County Building Industry Service Board.
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