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Permit CITY OF TIGARD PLUMBING PERMIT g COMMUNITY DEVELOPMENT Permit #: PLM2011 -00233 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/20/2011 TIGARD Parcel: 2S104AD06000 Jurisdiction: TIGARD Site address: 12932 SW SEVILLA AVE Project: Walnut Crossing lot 7 Subdivision: WALNUT CROSSING Lot: 7 Project Description: Installation of residential backflow preventer for irrigation. Contractor: JOHN DARBY LANDSCAPE INC Owner: PAHLISCH HOMES INC 13867 SW BENCHVIEW TERRACE 63088 NE 18TH SUITE 100 TIGARD, OR 97223 BEND, OR 97701 P PHONE: 541 - 385 -6762 PHONE: 503 - 579 -5298 FAX: 503 - 524 -6613 FEES Quantity Description Date Amount 1 ea Backflow Preventer 07/20/2011 $31.27 Specifics: 1 12% State Surcharge - 07/20/2011 $8.70 Plumbing 41 ea Minimum Fee Adjustment - 07/20/2011 $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, • • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility 1 otification Cente . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or d ect questions to OUNC • = i g 503.232.1987 or 1.800.332.2344. Iss ed By: / Permittee Sig :ture: 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. Jul 19 11 10:04a Kimmie 503 -524 -6613 p.3 Plumbing Permit Application Building Fixtures REtEiIVED FOR OFFICE USE ONLY n 1. City Of T Received ate/By: t 17 /J . ,i Permit-NO.: h as a - 3 13125 SW Hall Blvd, Tigard, OR m2z39 UL 19 2011 Plan Review a>xrPermit No.: Phone: 503.639.4171 Fax: 503.598.1 Datelly HO ayt i T I G A R D Inspection Line: 503. 639.4175 Date Ready/By: Anis: B &c rap age 2 for Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE OF wILDING DIVISION FEE* SCHEDULE yiaNew construction © Demolition For special information use ehecldist _ Description 1 Qty. 1 Ea. j Total Addition /alteration/replacanent ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION • SFR (1) bath 24920 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 Accessory building , 0 Multi- family SFR (3) bath 399.00 Each additional bathHatehen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 3 !) bl 13 �� v ��, Catch basin or area drain 16.60 City/State/ZIP: 1 er t { ) V ` ') / Drywell, leach Irate, or trench drain 16.60 Suite/bldg /apt no.: ect a l me ' : �f Fooling drain (no. linear ft.: ) :'age 2 Manufactured home utilities 110.00 ross directions to job site: Manholes 16.60 �! �' - Rain drain connector 16.60 Sanitary sewer (no. linear fl.: ) Page 2 Storm sewer (no, linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: - ,__) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK • Backflow pit-venter Page 2 Ai i c ' Backwater valve 16.60 �ilt.�_. � 1 .. : u .\ rte_ Clothes washer 16.60 Dishwasher j 16.60 PROPERTY OWNER • I ❑ TENANT Drinking fountain 16.60 Ejectors/srtmp 16.60 Name: 1 t ` 1 4 IL: /. Expansion tank 16.60 Address: litatMOMMEIMIEWIL ' CYO Phonic/sewer cap 16.60 I V Floor drain/floor sink/hub 16.60 City/State/ZIP: S'!;�`!�tAYf�t>L.il ►� w _ _ - Phone: ) ,52) i3. . Fax ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bill 16.60 Ice maker 16.60 Business name: Zekv ��Y z� fi ; tc C c Interceptor/grease trap 16.60 Contact name: J Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/ZIP: Roof drain (commercial) (6.60 i Sink/basin/lavatory 16.60 Phone: ( ) Fax: ( ) Tub/shower /shower pan 16.60 E -mail: Urinal 16.60 • CONTRACTOR . . . . . Water closet 16.60 Business name: 3 ' `'- Water heater /6.60 Address: 13 / 1 Ct 7 S 2!A .1) .itivi "t � !�.t t e od,a City/State/ZIP: a Sob ` ' `�/ ,� f / in Minim . um permit $72. ,, , so Phone :3 f ..5-7 V , 4` ,Fax :`�)3) ,5 L i - G ( 0 i Residential baekflow minimum permit fee: $3625 CCB Lie.: - 1 1l 0 Plumbing Lic. no Plan review (25% of permit fee) -- ,�` ��� State surcharge (12%ofpermit fee) g 7 Authorized signature: 6 __ � l TOTAL PERMIT FEE ,� Print name: `- �+ 1,1 A I Date: �� � �i J I This permit application expires if a permit is not obtained within � v ( 180 days niter it his been a as complete. *Fee methodology set by Tri -County Building Industry Service Board. • I.18ui7dir miMP,P p. doc 12/27A6 44 0.4616T {7 GYUZnC,'OM/IYPB) ______)