Permit a CITY OF TIGARD PLUMBING PERMIT
11111 2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00109
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 1 S135CA09800
Jurisdiction: Tigard
Site address: 11424 SW 96TH AVE
Project: Solera, Lot 7 Subdivision: SOLERA Lot: 7
Project Description: Installation of residential backflow preventer for irrigation system.
Contractor: TRADEMARK LANDSCAPES INC Owner: SOLERA LLC
P. O. BOX 2410 9200 SW NIMBUS AVE
OREGON CITY, OR 97006 BEAVERTON, OR 97008
PHONE: 503 - 631 -3893 PHONE:
FAX: 503 - 631 -4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/06/2011 $31.27
Specifics: 1 12% State Surcharge - 04/06/2011 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 04/06/2011 $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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �/ ` Permittee Signature: ' do",,, ' i
• 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 Application
Building Fixtures RECEIVED
Received ( -- / b Permit No.: /6
City of Tigard Date/By: '� � � ` V ��1
1111 il ,' 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: orris: See Page 2 for
TIGARD
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF WORK ! FEE* SCHEDULE
❑ D emolition For special information use checklist
❑ New construction Description I Qty. I Ea. I 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 ❑ Commercial/industrial
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:
1) 14 4- 1 , 9 1 61 - - - / - Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: l !' 9� 2 4' Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project ,
name:] • / ' _ Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
WE" . W /- -'. `,.F17 r /rr 0' • Sanitary sewer (no. linear ft.: ) Page 2
• Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer i 31.27 3 /j
Backwater valve 12.51
DESCRIPTION OF WORK 25.02
Clothes washer
3, ` i lee -ri / ih..) Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
- k '1 `� n --� Fixture /sewer cap 25.02
Name: V� ' VCq Y l A
( Floor drain/floor sirtk/itub 25.02
Address: C I' 8 J U r •
Garbage disposal 25.02
City /State /ZIP: 0 i ' i• 110OlD Hose bib 25.02
fof Phone: (553) 1 , .'1'J Le • Fax: 67 -12 ) "4:2A.P - 1 Ol0 Ice maker 12.51
■ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: • • U �� 12.51
■ � Primer
Contact name: �� 1 Roof drain (commercial) 12.51
Address: I ` b .. AI . 1 4' Sink/basin/lavatory 25.02
City /State /ZIP: i ��i� Solar units (potable water) 62.54
Phone: (3,1?) `r I-- t Fax: : ( ) Tub /shower /shower pan 12.51
Urinal 25.02
E -mail: re, t 1)_ 1 KD Water closet 25.02
CONTRACTOR Water heater 37.52
Business name:- FNY�. cSC�T Water piping/DWV 56.29
g oy, Address: _ Other: 25.02
City/State /ZIP: ' ' t\A DP---- l
�Q e 9--.1.04q Subtotal
Phone: (03.-- • ' 3 Fax: (5b 3 � 1 Minimum permit fee: $72.50 �5
°j Plan review (25% of permit fee)
Authorized signature: �
CCB Lic.: 1 '3 r 'J _ Plumbing L . no.: a State surcharge (12% of permit fee) `7l]
g r, TOTAL PERMIT FEE �S (,,, }
�; This permit application expires if a permit is not obtained within 180 days
Print name: L Date: after it has been accepted as complete.
.Fee methodology set by Tri- County Building Industry Service Board.
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