Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00239
- fIGARU 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/22/2011
Parcel: 2S 110BC00900
Jurisdiction: Tigard
Site address: 12475 SW BULL MOUNTAIN RD
Project: Tigard 10 MG Reservoir Transfer Pump Station Subdivision: AMES ORCHARD Lot: 5
Project Description: Irrigation backflow preventer.
Contractor: ASHLAND BROTHERS LANDSCAPES Owner: TIGARD WATER DISTRICT
2153 MOLALLA HIGHWAY 8777 SW BURNHAM ST
WOODBURN, OR 97071 TIGARD, OR 97223
PHONE: 503 -981 -6131 PHONE:
FAX: 503 - 981 -1058
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/22/2011 $31.27
Specifics: 1 12% State Surcharge - 07/22/2011 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment - 07/22/2011 $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 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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / / Permittee Signature: (57-19, L le��
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. / v
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.
Ashland Brothers , - ri„c 503 - 981 -1058 p.2
Plumbing Permit Applica - t VEi
ngen
Site Utilities If 21 FOR OFFICE USE ONLY
1. City of Tigard 2011 DOt / B e d /O1 fj/
IN
• 13125 SW Hall Blvd.. Tigard, O
Date /B /0��� ��., Permit No Q a 3
9 Plan Re ie t,
0 Phone: 503.718,2439 Fax: 3`59 vex) 1 tv.2;tgilQ date /B y: Other Permit No.:
TIGARD
Inspection Line: 503.639.4175t U}LDINtG DIVISION D. Ready :By: lurks / y2 See Page 2 for
Internet: www.tigard -or.gov Notified /Method: 11 (� Supplemental Information
1 TYPE OF WORK FEE SCHEDULE
! ® New construction ❑ Demolition For special information use checklist.
Description I Qty. f Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1. 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
f2 I - and 2-family dwelling SFR (2) bath 437.78
g ® Commercial /industrial
1:1 Accessory building ❑ Multi - family SFR (3) bath 50032
CI Master builder ❑ Other:
Each additional bath/kitchen 25.02
Fire sprinkler ( sq. (L) Page 2
• JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 12475 Bull Mountain Road Catch basin or area drain 18.76
Drywell, each line, or trench drain 18.76
City / State/ZIP: Tigard, OR 97223
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 10mg Reservior Improvernen Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: It Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: 1 Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Irrigation system including backflow Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
3 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: City of Tigard
Fistore/sewer cap 25.02
Floor drain /floor sink/huh 25.02
Address: 13125 SW Hall Blvd
Garbage disposal 25.02
City / State/ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: (503)718 - 2283 Fax: ( ) Ice maker 12.51
CT PERSON Interceptor/grease $ trap ® APPLICANT Enter tor/ rease tra 25.02
Business name: Ashland Brothers Landscaping, l JLCB #'7174 - Medical gas (value: $ ) Page 2
Primer 1 2.51
Contact name: Terri Castro /3Q��,�
` Roof drain (commercial) 12.51
Address: 2153 Molalla Road P.O. Box 130 Sink/basin/lavatory 25.02
C ity / State/ZIP: Woodburn, OR 97071 Solar units (potable water) 62.54
Phone: (503) 981 Fax: : (503) 981-1058 Tub /showerlshowerpan 12.51
E -mail: terri @ablandscapes.net Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: James W. Fowler Co. Water pP 1 m D1VV 56.29
Address: 12775 Westview Drive Other: 25.02
City /State/ZIP: Dallas, OR 97338 Subtotal
Phone: (503) 623 -5373 Fax: (503) 623 -9117 Minimum permit fee: $72.50 72.50
` Plan review (25% of permit fee)
Cal Lie.: Plumbing Lic. no.:
Authorized signature: r� State surcharge (12% of permit fee) 8.70
n R L TOTAL PERMIT FEE 81.20
This permit application expires if a permit is not obtained within 180 days
Print name: Terri Castro Date: 7 -21 -11 1 after it has been accepted as complete.
" 1 ce methodology set by Tri "County Building Industry Service Board.
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