Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00234
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/20/2011
Parcel: 2S 104AD06100
Jurisdiction: TIGARD
Site address: 12954 SW SEVILLA AVE
Project: Walnut Crossing lot 8 Subdivision: WALNUT CROSSING Lot: 8
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
TIGARD, OR 97223 BEND, OR 97701
PHONE: 541 - 385 -6762
HONE: 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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifica enter. 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 tions to O NC by c ing 503.232.1987 or 1.800.332.2344.
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.
Jul 19 11 10:05a Kimmie 503 - 524-6613 p.5
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard EIVIED D Received , ? f 7 i Permit No.: i Voierf a:Z.Z3
111 ° I 13125 SW Hall Blvd., Tigard, OR 9
II Phone: 503.639.4171 Fax 503.598.1960 "w 0th« Permit No.: HOrky/A--eretiaiti
T tG '+ R O inspects Line 503.639 g0.4v175 JUL 1 9 ?nil Dare Ready/By: r, : 1a See Page 2 far
In t:rne t: tYww. OX. gOV
Notified/Method: Supplemental Information
. • TYPE of woRiErry OF TIGAKD ,, [ FEE* SCHEDULE
New construction (:1I.t lj! :r%t.4
For special information sae CheeVaL
Description
• ❑ Addition/alteration/replacement 0 Other: Ne 1- 12-family . Total dwellings (includes 100 it for each utility connection)
CATEGORY OF CONSTRUCTION SFR. (1) bath 24920
! ;Q: and 2- family dwelling ❑ Commercialfindustrial SFR (2) bath 350.00
❑Accessory building ❑ Multi - family SFR (3) barb 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( _ sq. &_) Page 2
/2 9 5# JOB SITE INFORMATION AND LOCATION Site utilities
lob site address: {kJ , 111 OA A ye, Catch basin or area drain 16.60
City /State/ZIP: ' 44 b 0 V C 7g93 Drywell, leach line, or trench drain 16.60 R
Suite/ Idg:I.apt. no. 3J Project name: Footing drain (no. linear : ) Page 2
Manufactured home utilities 110.00
ss street/ erections to job site
—
Manholes 16.60
. Vii./1\ WUt Rain drain connector 1 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R: „!) Page 2
1 Water service (no. linear ft.: _,_) Page 2
Subdivision: Lat no::
I Fixture or item
Tax map /parcel no.:
-
Absorption valve 16.60
• DESCRIPTION OF WORK Backtlow preventer Page 2
�R11 > g I ) id , _ -
r 'il Backwater valve 16.6D
` - Clothes washer 16.60
.,
Dishwasher 16.60
0 PROPERTY OWNER I . ❑ TENANT Drinking fountain 16.60
p' (� Ejectors sump 16.60
Name: ` J
L( c� L a Expansion tart 16.60 • Fixture/sewer 16.60
Address , co V
City /State/ZIP: 1!fii% 4 ( a � t i `,= i Floor dr in/tloorsink/hub 16.60
Phone: 515 ) i3 Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib I6.60
Ice maker 16.60
Business name: ! `C ?
sJ Vt,1 n �,t"1[ v'b r c ■ • Interceptor/ 1 660
Contact name: Medical gas (value: S ) Page 2
Address: Primer 16.60
City/State/ZIP:
Roof drain (commercial) 16 -60
Phone: ( ) / Fax :: ( )
Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E-mail: Urinal 16.60 i
CONTRACTOR . Water closet 16.60
Business name: 1 Water heater 16.60
Address: ) 38' 7 t u ` . ,47,6 6 a0 gii ` '_. _ der
City /State/ZIP: • ` "7 y-� Subt 6iiFTh
1 ) C�' . � Minimum permit f 57
Phone: i(�5ff3 ��' ` t`' - �j F) `�'� '� o a_ 3 Residential backfow nsinimum permit fee. 701 • 50
CCB Lie.: — I /1 0 Plumbing Lic. no.: Plan rev (25% of permit fee)
State surcharge (12%ofpermit fee) 6,7e
Authorized signature; TOTAL PERMIT FEE gi,alc)
Print name: c314.0 k c ( Date: 7 )9 �' j This permit application expires if a permit is not obtained within
J v t 1 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
LIBuildinal MF.P- .. . p.doc 17127/06 440- 4616T(10/02/COMWWEB)