Permit �� CITY OF TIGARD PLUMBING PERMIT
14 , COMMUNITY DEVELOPMENT Permit #: PLM2011 -00208
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2011
Parcel: 2S 108AB04300
Jurisdiction: TIGARD
Site address: 14104 SW 155TH TER
Project: Brentwood Estates, Lot 5 Subdivision: BRENTWOOD ESTATES Lot: 5
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: TRUSCAPES INC Owner: DREAMBUILDER CUSTOM HOMES
21600 NW ANBERWOOD DR. 13115 SW JAMES LN
HILLSBORO, OR 97124 TIGARD, OR 97224
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PHONE: 503 - 880 -7132
PHONE: 503 - 969 -2144
FAX: 503 - 352 -4607
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/01/2011 $31.27
Specifics: 1 12% State Surcharge - 07/01/2011 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 07/01/2011 $41.23
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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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 Notifi - ': • -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire •uestions to OUN •y c• ins 5a .232.1987 or 1.800.332.2344.
Iss ■•d By: )„......... , / / / Permittee Sign
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.
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Jul 01 2011 6:49RM DRERMBUILDER HOMES 503 -821 6462 p.2
Plumbing Permit Application
Site Utilities FOR OFFICE VSF. ONLY
City of Tigard Received ' 7 NINA Dale/BY: Permit Na.: r -ezvV.0.
'{ 13125 SW Hall Blvd., Tigard, OR 97223 plan Review
` Phone: 503.718.2439 Fax: 503.598.1960 Date 13y: other Permit No.:
T I G A R t3 Inspection Line: 503.639 Date Ready /By: lurk : la See Page 2 for
Internet www ugard - gov NotifiedlMethod Supplemental i£ �`' ? . : U u I i Psi u, t_ <a PPI emental Information
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® New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Additionfalteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
~alt s M tra; e - ri• x £' v r" ctet j t ?M =a i i s +F 7: 1 t; SFR 1 bath
. ::': t i11 Y: L4 •- "t - .i S Y :�v»�.',44. 1 m ' b s. ;!1 �! f La a . 411 Hfllllt�itli. 11111i (" 1
® 1- and 2-family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
0 Accessonybuilding ❑ Multi- family
SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other:
# s'turr r 1t� r a , , a r a r _ _ Fire sprinkler ( sq. ft. Page 2
t� .r.: •> iM s..t 1r„ ; 3:c, l 1,�t,,' a l�t t , ..:f, l r ;. ",m t `inittilIf 4s 1.('il j sit • ut ilit ies :
Job site address: 14184 SW 155 Terrace Catch basin or area drain 18.76
City / State/ZiP: Tigard, OR 97224 Drywell, leach line, or trench drain 18.76
Footing dram (no. linear ft.; ^) Page 2
Suite/bldg./apt. no,: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
■
Brentwood Estates lot 5 O 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 31.27 1
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t aex., 1, : n 7IIIII P
�, �€ 8 ** -'�l. � �'is � �� � t ,t } t� 12.51
a' $ . � _rrY #r,t, -. ". `'. � ilfi r £ r I 9 .�f s r .1 11� IPI A71( t t� l.: Clothe w her
'rr u. c . x {II° a E, +� ...�.•.. � .tP. � 1r� 4 4 ( Ar _Z...i . «.e.c... -
irrigation backflow preventer
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
y Ejectors /sump ' 25.02
's,,.k • 1 6 t ¢: 2 g« `i r * ni ?§'1{ {' Irt[l� € a (rt e t lI xE }1 r 'tt`ip SBI ' {, Expansion tank
,......,, ,,,,, .. ._ ; .4 >!t_i4m_ y :t :..nwAtii :A�.»e , =j!, tiIK t.` ila.F •OV. . a.i. )44. 1Br � P 12.51
Name: DreamBuilder Custom Homes o Fixture/sewer cap 25.02
Address: 13115 SW St James Ln Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /State /ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)880 7132 Fax ( ) Ice maker 12.51
s r � - i (,a ,. ' 6 ya ,a¢,�a',[( ,t�td'" 3 l � by . 3.� t a tq a ' s EI I £ `1t pit` "7 Y € iy L . ."-,. '"t `w fK ,
pa .... 88a. se .. _ s . 1tt43a3 e v. t z� ....e.. , n.a�zSt7, . .§ ' i.e. _ :.(rl rasrl..ran..Han. ale aatm.nr t . Interceptor/grease tra p 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name: Primer 12.51
Roof drain (commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/shower /shower pan 12.51
E -mail: Urinal 25.02
'' e ft}i.x -a t �w" :, i . 1 2 d `- .r t .r� l S :4211'.T.M tl:i mt td . - Water closet 25.02
1a n at. i;. cot t ' Ii...nt ,Y., i` - tr,i � . _ , tt 6 1,.1 ',::�,1a r'u- iltl ..e 1P 17iC(t.tfit y ..:x:,r� s r . V . ,
Water heater 37.52
Business name: Truscapes Water piping/DWV 56.29
Address: 21600 nw amberwood dr Other: 25.02
City / State/ZIP: hillsboro 97124 Subtotal
Phone: (503) 969.2144 Fax: (503) 352.4607 Minimum permit fee: $72.50
CCB Lie.: Icb7962 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signal /J r _ State surcharge (12% of permit fee)
�trt✓«`"" TOTAL PERMIT FEE
Print name: Terry Peniuk Date: 7/1/2011 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"'Fee methodology set by Tn- County Building Industry Service Board
1 : 1 Eui permitApp.doc 1C!01/09 440- 4616T(10 /02/COM/WEB)
1