Permit PLUMBING PERMIT
r , CITY OF TIGARD ti
COMMUNITY DEVELOPMENT Permit #: PLM2011 00256
TIG 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/11/2011
G }
Parcel: 2S104DCO2900
Jurisdiction: Tigard
Site address: 13287 SW CLEARVIEW WAY
Project: Hutchinson Subdivision: BENCHVIEW ESTATES Lot: 29
Project Description: Replace irrigation backflow
Contractor: JORGE'S TOTAL YARD MAINTENANCE Owner: HUTCHINSON, LARRY
26815 SW FARMINGTON RD 13287 SW CLEARVIEW WAY
HILLSBORO, OR 97123 TIGARD, OR 97223
P
PHONE: 503 - 545 -2720
PHONE: 503 -709 -1308
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/11/2011 $31.27
Specifics: 1 12% State Surcharge - 08/11/2011 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 08/11/2011 $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. r
i
Issued By: I P ermittee Signature: f •
r(C / y - U 0 lei •
/ 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 o the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicatio CEWED
Site Utilities FOR OFFICE USE ONLY' •
Tigard AUG 11 2011 Received
City of Ti �I� /_
`, g Date/By:
// ti Permit No.:PLlti D/ �Q .j �
11
. v 1 3125 SW Hall Blvd., Tigard OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.59 OF TIGARD DateBy: Other Permit No.:
Inspection Line: 503.639.4175 B UILDING DIVISION
T I G'A R D` Date Ready/By: lust / See Page 2 for
.. Internet: www.tigard - or.gov Notified/ Method: /7 H Supplemental Information
fi' 1, �s+.." s _. v ? sr. f`T '; :'.'..,4, _ , '4 ,:,:vii; , .. as ..
,, . 1 `. , . ". :,TYPE OF WORK {' ,:: . �� ; , .Ji;43t P.-f rr, N v" gg FEE' SCHEDULE ..'0'.7-1. ' ' a ?'?
..n S' .e _ .. .. .\ � , , x. .< ?, a .� .�..mk .AS .,.<,... ...Y. u _ 1 n42 �.. .�ek %���� .. n ...� � .V _ ., � d^ �,' : '* t
❑ New construction ❑ Demolition . For special information use checklist.
Description I Qty. Ea. 1 Total •
❑ Addition/alteration/replacement Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
, v, , t° t , , n, ,,, CATEGORY OF CONSTRi7I
CTO1V� � j'� " ?' § y �„ , ? SFR (1) bath 312.70
® m
1- and 2- family dwelling ❑ Comercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
. ° hi Ra ° +:. �. - . .�.. ,
. na.; . , ..� -_E r' - ._. ^'.:rr.c � :.� , t ..r av . .. ,..:w
s , c a'e'� - , i
, y i
, ^: e ,,,,, -, ".. , - r •SI INFO 'i1ND' L OCA I IU N; °� c+y` S ynF.^ 6 N °'; Site utili ties:
„ - .. $x � 'n al v"_ .� . ' , .h� - ..E__ 'it +;v Y. -'c. "y,g',��, �_�: .. r.' 4., F% ePCtisa' 4'+ S• � �n�A f:}�'.£j.�'9?'.f�d� ,}
Job site address: 13287 SW Clearview Way Catch basin or area drain 18.76
Drywell, leach 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: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
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
:i:,;:k,` , : �... ti..v t.1:; .a vi;,. Backwater valve 12.51
.„, ' �, ' WO a . a . w._� � ,.. `
_ „ -'v .r.s'," .7._'.,•:„ ...__.._-, . ,, o - . - ..RK•�`. t'., ,a�: I ..''' a�
Clothes washer 25.02
/fi-X/ (Tr r9 // /34 i /Gj7n.) Q &7 "/ &7V7 Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
#PROPERTY OWNE ,. ' , l ° rh ° , -" f'"`' ,". :2 '� Expansion a;`. ,> ��_ . � • .....e `, `,r'm ,; i "f .v. ' $- �� ' .. -. ®��,TErIANT,'� .ti. >� . r a ` � xpansion tank 12.51
Name: Larry Hutchinson Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13287 SW Clearview Way
Garbage disposal 25.02
City/State /ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: (503) 545 -2720 Fax: ( ) Ice maker 12.51
JY Y'1 .t - .� e
. 1 .. " 5 . ® APP,LIGAN'T- ), � , _ , � t y _ ❑ CONTACT„ PERSON ` , t ' -:' Interceptor /grease trap 25.02
f � -.".-raw",., ,.
Business name: Jorge's Total Yard Maintenance Inc. Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Jorge Valdes
Roof drain (commercial) 12.51
Address: 26815 SW Farmington Rd Sink/basin/lavatory 25.02
City/State /ZIP: Hillsboro, OR, 97123 Solar units (potable water) 62.54
Phone: (503) 709 -1308 Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: jorgestym @gmail.com Urinal 25.02
. d �" - _ q Water closet 25.02
` ''„ ,v .. ss+ :y 4 r- : 7 ;'. > =,1, ,�:tvCON'ACTOR,: , ciA,- .y ;,, ''; >t
,.d .... .e ,.,, Water heater
_I� _, , 37.52
Business name: Jorge's Total Yard Maintenance Inc Water piping/DWV 56.29
Address: 26815 SW Farmington Rd ' Other: '25.02
City/State /ZIP: Hillsboro, OR. 97123 Subtotal
Phone: (503) 709 -1308 Fax: ( ) Cnl� 59°E Minimum permit fee: $72.50
�,' ''02 , Sa
�/' i/ Plan review (25% of permit fee)
CCB Lic, /7.6 F �Q / �i�
lumbing Lic. no.: C _
r State surcharge (12% of permit fee) F , 70
Authorized signature: o r vl �. 3�-9 / /d- I TOTAL PERMIT FEE P a c)
Print name: Jorge Valdes Date: 08/11/2011 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Pmnits\PLMU- PemtitApp.doc 10 /01/09 440- 4616T(10/02/COM/WEB)