Permit CITY OF TIGARD PLUMBING PERMIT
7 COMMUNITY DEVELOPMENT Permit PLUMBING
PLM2011 -00108
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 1 S135CA09700
Jurisdiction:
Site address: 11436 SW 96TH AVE
Project: Solera, Lot 6 Subdivision: SOLERA Lot: 6
Project Description: Installation of residential backflow preventer for irrigation system.
Contractor: TRADEMARK LANDSCAPES INC Owner: EVERETT CUSTOM HOMES
P. O. BOX 2410 735 SW 158TH AVE STE 180
OREGON CITY, OR 97006 BEAVERTON, OR 97006
P
PHONE: 503 - 750 -6268
PHONE: 503 - 631 -3893
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
41 ea Minimum Fee Adjustment - 04/06/2011 $41.23
Type of Use SF 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 Notificatio - ter. 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 qu- ons to O C by calling 503.232.1987 or 1.800.332.2344.
Issued B Permittee Signature for
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 RECEIV FUR O l( I. ' `i. O`I,\
City of Tigard DaeBed Permit Permit No.: �G/�aor/-oohQ OF
. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 CITY OF TIC,., Date Ready/By: Juris: IA See Page 2 for
Internet: www.tigard - or.gov n r , 7 � p Noti6ed/Method: Supplemental Information
BIT . ..t3t i! , a :FYI ! .. . ;
TYPE OF WORK FEE* SCHEDULE
For special information use checklist
❑ New construction ❑ Demolition Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New I- 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: f
1 3 4 -�� Aye__ Catch basin or area drain 18.76
q u --
Drywell, leach line, or trench drain 18.76
City /State /ZIP: t C 14 0 t. CO& 9 1'2% , Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name:_. C tp1-D Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
g Sanitary sewer (no. linear ft.: _) Page 2
r Sto rm 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 l l 31.27 31)7
Backwater valve 12.51
DESCRIPTION OF WORK 25.02
I Clothes washer
(3��C 1417c/11.-) Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER El TENANT Expansion tank 12.51
25.02
� ' M n -7 Fixture /sewer cap
Name: 'r � C➢ `t 1� S
�`� �a (
Floor drain/floor siric/ttub 25.02
Address: I Y J (..) I Garbage disposal 25.02
City /State /ZIP: \ CAL , G 1 '1 V0 ( - 0 Hose bib 25.02
Phone: (5-63) . 1 ." l.Q Fax: 6 . - 4:2A.p • - i 1 OW Ice maker 12.51
• L APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
i�I _ � 12.51
+ '\ ,/ 1 P r i mer
Contact name: / Roof drain (commercial) 12.51 • Address: I \. b � / 1" y' Sink/basin/lavatory 25.02
City /State /ZIP: r !b
ie LOW , T Solar units (potable water) 62.54
Phone: (3) 'J t Fax: : ( ) Tub /shower /shower pan 12.51
Urinal 25.02
E -mail: (A \_, €Q-\O Gl • Gt�(N- Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: ��- S Water piping/DWV 56.29
Address: r
n \C ST Other: 25.02
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City /State /ZIP: • ' tircAy - �'p Subtotal
Phone: ( J
�� / C7 3 Fax: 1 2 - L 5 1 Minimum permit fee: $72.50 ) _ _ c )
Plan review (25% of permit fee)
CCB Lic.: I t -3-5 c Plumbing ie. no.: -3 a
g State surcharge (12% of permit fee) ,i - '?(d
Authorized signature: F / TOTAL PERMIT FEE <
1 -NA,. This permit application expires if a permit is not obtained within 180 days
Print name: L r� Date: after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doe 10/01/09 4404616 (10 /02/COM/WEB)