Permit ^ !� CITY OF TIGARD PLUMBING PERMIT
; ' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00196
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/22/2011
Parcel: 2S108AB04100
Jurisdiction: TIGARD
Site address: 14180 SW 155TH TER
Project: Brentwood Estates, lot 3 Subdivision: BRENTWOOD ESTATES Lot: 3
Project Description: Install residential backflow preventer for irrigation.
Contractor: 4 A LANDSCAPE & IRRIGATION INC Owner: PAHLISCH HOMES, INC.
19575 CLEAR NIGHT DR 63088 NE 18TH, SUITE 100
BEND, OR 97702 BEND, OR 97701
PHONE: 541 - 385 -6762
HONE: 541 - 419 -3003
FAX: 541 - 312 -8793
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/22/2011 $31.27
Specifics: 1 12% State Surcharge - 06/22/2011 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 06/22/2011 $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 N 'cation Comer ter. Those rules are set forth in OAR 952 - 001 -0010 throw ■ l A = 95 -I e' -1 i' 1. You may obtain a copy of the rules
or dir t questions to OUN \ .y c.Ilin• - 13.232.1987 or 1.800.332.2344. - 411k
Issu d By: / Permit •e Signature: ,J�
/ �
� :rr
Call 503.639.4175 by 7:00 a.m. for the next available'- pection 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 FOR OFFICE USE ONLY
Received / / � /n
11 -
City of Tigard Date/By: / Permit No.: T(O
U 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.59:. "0� Date
/By:
Date/By: Other Permit No .:M Q/ /_� 3
T 1 G A R D Inspection Line: 503.639.4175 ♦ q S Date Ready /By: mss: Fa See Page 2 for
Internet: www.tigard - or.gov V Q Notified/Method:. Supplemental Information
TYPE OF WORK , �~ � FEE* SCHEDULE .
lew construction ❑ Dem ` .V For special information use checklist
For I Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Othe New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION < SFR (1) bath 312.70
0'I- 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
J INFORMATION AND LOCATION Site utilities:
Job site address: - _---- - - H.. Catch basin or area drain 18.76
`
'� I Q r r� C Drywell, leach line, or trench drain 18.76
City /State /ZIP: C ( 01Z. Drywell,
drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: Q 0 .- bS--1)k, rj AID Manufactured home utilities 50.03
Cross street/directions to job site: u., , n U. Vlitti h 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: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 1 31.27 3 ( .tXj
DESCRIPTION OF WORK Backwater valve 12.51
��
J'- Clothes washer 25 -02
1Yl� a It ec irr ■∎�G� UN -Cto1Q Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER l ❑ TENANT - Expansion tank 12.51
Name: Tf'Jly \ki`�' \ � �s Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51 -
a APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: 4 / (� J1 c o ni c r, Medical gas (value: $ ) Page 2
""`�r ` uu rt` v� Primer 12.51
Cnntart name. .. -..... D. 'i .- " '. Roof drain (commercial) . 12.51
Address: 1t15`l�,> � ��/� , �
` Sink/basin/lavato ry / 25.02
City /State /ZIP: xvi, em CM() 7 Solar units (potable ware 62.54
Phone: ( i1) t.1 lq-3,,,0 Fax: : 1) 31 _ o I Tub /shower /shower pan 12.51
mail: trip @ Urinal 25.02
E -
�D urcL la r c - @ a he . fin-. Water closet 25.02
-- CONTRACTOR
Water heater 37.52
Business name: 1(kl &% QIntr*Q Water piping/DWV 56.29
Address: Other: 25.02
City/State /ZIP: Subtotal
permit fee: $72.50
Minimum
Phone: ( ) Fax: ( ) P
CCB Lic.:
L-[-,tt:' 8 2_2_ 1/54y Plumbing Lic. no.: Plan review (25% of permit fee)
( State surcharge (12% of permit fee)
Authorized signature: X 9, �, TOTAL PERMIT FEE , O
Print name: ' ct..\ l ne, � V f Dater I� I I 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.
1:t Building \Permits\PLMU -PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) 4 i