Permit CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit #: PLM2011 -00114
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/07/2011
Parcel: 1 S 125CD06100
Jurisdiction: Tigard
Site address: 9810 SW LANDAU PL
Project: THOMPSON Subdivision: Lot: 0
Project Description: Backflow for irrigation.
Contractor: LANDSCAPE EAST & WEST Owner: THOMPSON, SCOTT S &
PO BOX 430 SHARON WALSH
CLACKAMAS, OR 97015 9810 SW LANDAU PL
TIGARD, OR 97223
PHONE: 503 - 804 -1741
HONE: 503 - 256 -5302
FAX: 503 - 297 -6993
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04 /07/2011 $31.27
Specifics: 1 12% State Surcharge - 04/07/2011 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 04/07/2011 $41.23
Plumbing
Class of Work: ALT
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.
l
Issued By: Permittee Signature:
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
Site Utilities FOR OFFICE USE ONLY
City of Tigard CO ate/By: L � y� P ermit No.: 0 K
. 13125 SW Hall Blvd., Tigard, OR 97223 `
�^�./ Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Date/By: Other Permit No.:
T I G ARD Inspection Line: 503 �, f • Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov c) <1 Noti(ed/Method: -17G2 Supplemental Information
- TYPE OF WORK we
, 4 9
FEE* SCHEDULE
❑ New construction ❑ Demolitipih t ' ,�V For special information use checklist
v ,�,� Description 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: 9810 SW Landau Place Catch basin or area drain 18.76
City/State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: Thompson 2500911 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
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:
i Tax map /parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Install backflow preventer
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Thompson, Scott & Sharon Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 9810 SW Landau
Garbage disposal 25.02
City/State /ZIP: Tigard OR 97223 Hose bib 25.02
Phone: (503)804 -1741 Fax: ( ) Ice maker 12.51
❑ APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: Landscape East & West Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Tina Schilz
Roof drain (commercial) 12.51
Address: PO Box 430 Sink/basin/lavatory 25.02
City/State /ZIP: Clackamas OR 97015 Solar units (potable water) 62.54
Phone: (503) 256 -5302 Fax: : (503) 297 -6993 Tub /shower /shower pan 12.51
E -mail: tinas @landscapeeast.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Landscape East & West Water piping/DWV 56.29
Address: PO Box 430 Other: 25.02
City/State /ZIP: Clackamas OR 97015 Subtotal
Phone: (503) 256 -5302 Fax: (503) 297 -6993 Minimum permit fee: $72.50 72.50
CCB Lic.: 181577 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
Print name: Tina Schilz Accting Mgr Date: 4/4/11 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
°Fee methodology set by Tri- County Building Industry Service Board. °
I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)