Permit CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit #: PLM2011 -00231
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/19/2011
TIGARD 13125 2S112CB04700
Jurisdiction: Tigard
Site address: 8287 SW ASHFORD ST
Project: Schuck Subdivision: Lot:
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: CORNERSTONE HARDSCAPES Owner: SCHUCK, EUGENE R & MELISSA K
8700 SW YAKIMA CT 8287 SW ASHFORD ST
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -6542 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/19/2011 $31.27
Specifics: 1 12% State Surcharge - 07/19/2011 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 07/19/2011 $41.23
Type of Use SF 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 dire uestions to ` NC b .)ling 503.232.1987 or 1.800.332.2344.
Issue By: / ` � / Permittee Signature: re
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
Building Fixtures FOR OFFICE USE ONLY
CEIVED Received
II City of Tigard Date/By: 1 17 it & , /, Permit No.: t4 ..e/9 3/
- v 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2439 Fax: 503.598.196 Plan Review
9 ■ L 1 2 2011 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard- or.gov OF TIGARD Notified/Method: Supplemental Information
TYPE OF WO ILDING DIVISION FEE* $CIIEDULE
•
❑ New construction ❑D e m olition For special information use checklist
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
Accessory building ❑ Commerciallindustrial
❑ Multi- family SFR (2) bath 437.78
SFR (3) bath 500.32
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:
;' 7 n 1 `A J St. K- _ (7 i , Catch basin or area dram 18.76
-
�
1 1 Drywell, leach line, or trench drain 18.76
City /State /ZIP: y &(1c( , n 2 q 7 aa�J
`! Footing drain (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
\ A \ � 1 1 � t K (. � -� ` Ul Rain drain connector 18.76
T A I j x 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 l 31.27
DESCRIPTION OF WORK Backwater valve 12.51
t\ /1 4 S 1 rJ Q( Clothes washer 25.02
S Aern Dishwasher 25.02
�J Drinking fountain 25.02
Ejectors /sump 25.02
V PROPERTY OWNER I ❑ , TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name: PlQkis Sc._ Floor drain/floor sink/hub 25.02
Address: O a.5, 5J 5P G -. 9 . Garbage disposal 25.02
City /State /ZIP: T• t c X CJ �� R 9-74D4 Hose bib 25.02
Phone: (S) G, q a.a Fax: ( ) Ice maker 12.51
❑ APPLICANT . ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: 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
CONTRACTOR .
Water closet 25.02
• Water heater 37.52
Business name: Co nee5 -, fv 1 1 0.CttS (6.p e 5 Water piping/DWV 56.29
Address: 8700 51.0 )'4K1 NA e.--r" Other: 25.02
City /State /ZIP.. :,. v 2 9 x A2 _ Subtotal
Phone: ( ,q g - LID_ 1 I Fax: ( ) 4 CO
Minimum permit fee: $72.50 7 Plan review (25% of permit fee)
�.
CCB Lic.: - a�' 71311/1 Plumbing Lic. no.: State surcharge (12% of permit fee) ' • 76 -
(,
Authorized signature: L ^T V I Vi TOTAL PERMIT FEE g'l .go
Print name: Pf31 ' Date: This permit application expires if a permit is not obtained within 180 days
VI C ) {� V �' �, 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)