Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00153
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/16/2009
Parcel: 2S112CB04000
Jurisdiction: Tigard
Site address: 8447- .SW- ASHEORD,.ST
Subdivision: ASHFORD OAKS NO. 2 Lot: 54
Project: Bradley
Project Description: Install backflow device.
Owner: FEES
BRADLEY, WILLIAM L & ANN P Quantity Description Date Amount
•
8447 SW ASHFORD ST
TIGARD, OR 97224 1 ea Backflow Prevention - RES 06/16/2009 $27.55
PHONE: 1 12% State Surcharge - 06/16/2009 $4.35
Plumbing
9 ea Minimum Fee Adjustment - 06/16/2009 $8.70
Contractor: Plumbing
LANDSCAPE ENTERPRISES INC
PO BOX 436
WILSONVILLE, OR 97070 •
PHONE: 503 - 682 -3343
FAX: 503 - 682 -3343
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Stories:
•
Total $40.60
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 -0100. You may obtain a copy of the rules
or direct question to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: *mil ( Permittee Signature: • Op
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
t ' r E I FAX NO. :5036823343 Jun. 15 2009 10: 06AM P2
Plumbil Pe rmit Application
RECEIVED 4 a
Building Fixtures E+ 1Ou O1 I:u L l (��1:� , �: .,
Received Permit No.:
{ •, : City of Tigard ane,13y: f "Lill 2009
���
t'•'- " n 13125 SW Ilan Blvd., T i g a r d . , 9g 3 2009 Plan IZL\iC\1
' 2 Phone: 503.639.4171 Fax: '501.5 960 D ate; B • Other Permit No..
Inspection Line: 503 639,4175 TWA!) Bate Ready/Ay: Jun%: f!i See Page 3 For
,;'ig Internet: w�ww.tigard- or.kd%T}( Notified/Method 1 Su lem tntormatlea
I �- TYP:El JD FEE* SC FDiJLE -
❑ New construction - - ❑ Demolition For special information use checklist. -
I I "" � w_ Descri Qty. Ea . j T otal
-- Addition/alten tion/replacement ❑ Other. New 1- 2 - family dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRICTION SFR (I) bath 244.20
Uindustriol SFR (2) bath 350,00
A I- and 2V • fam dw:ellin l3 0 Commercia
Accessory building
[] Multi •
sFR (3) bath 399.00
❑ rY - ,_ - ._. _ Each additional bath/kitchen 45.00
[] Master builder ❑ Other. Fire sprinkler . ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: .g 23,4 7 5 ix ) As Y"lir -c . 5+. Cateh basin or area drain 16.60
C ity /State/ZIP: � d C5 T t Drywcll leach linc, or trench drain 16,60
Suite/bldg. /apt. no.: Project name: / Footing drain (no_ iineet ft: Page 2
_. Manufactured home utilities 110.00
Cross street/dircctions to job site: ) .4 1 ., 1 Manholes 16.60
Rain drain cotmector 16.60
Y Sanitary sewer (no. linear ft.: _) Page 2 . • �l Yl Pl. a. ' - •: f • ( rS 5 - i ( _ M 7) Sturm sewer (no. linear ft : Page 2
..
Subdivision: Lot to.: Writer service (no linear IL: ) _ Page 2
_• ..__ _. Fixture or item _
Tax map/parcel no,: Absorption valve 16.60
- DESCRIPTION OF WORK - Rackflow preventer Page 2
/7 yA ' /_ G(� �"�` Backwater valve 16.60
Clothes washer E6 -60
_At - ..- Dishwasher 16.64
Drinking fountain 16.60
PROPERTY OWNER CI TENANT . .- -
-.. Ejectors/sump 16.60
Name: zZ . -- J -.
Lt I f N� amt Expansion tank 16.60)
Address: Fixture/sewer cap 16.60
e 4y 7 5w 1� trot.�j ur _. ,_. 1 . -
City /State/ZIP:' - "r. .ct t De-, C I]
9-24 _
Floor drai&floorsink/huh 16.60
Phone (53 ) L4 Fax: ( ) Garbage disposal 16.60
..__ � ._ How hih 16.60
g APPLICANT 1i CONTACT PERSON ...__.., -w-
- _,_ - lee maker 16.60
Business name; n czl(L E, f p1 1Sc 1 r c.. , Interceptor/grime mse trap 16.60
Contact name: �U i GL- & -- T PA -- Medical gas (value: S ) Page 2
•
Address: --p a ax !) 3(t) Primer 16.60
City /State/ZIP: . ) 15 y i tI , Og 6116-2D Roof drain (commercial) - 16.60
1 Sink/basin/lavrnory 16.60
Phone: (5Q3) I 3`x I fax :: (r6);) WU - -3343 TUb /shower /showcrpan 16.60
E -mail: n pay Q. p[,o t , Co m _ Urinal 16.60
CONTRACTOR Water closet 16 -60
Water heater • 16.60
Business name: Y- jaC e__ pri-te r pc? S e S o I r,t. • _ . --. -
Address: -po . x alp . _ _,_ Other_ -
"
City/State/ZIP: Subtotal 3ta . ?.
Ci
ty W; I se n If L. h ., . 01 0 � • Minimum permit fee: $72.50
Phone: (565 ) (O g t - 3 3 43 Fax: (5 i3) ip r 2.- 3343 Residential backflow minimum permit fee: $36.25 0 . Z5
CCB Lie.: /7 7 Plumbing Lie. no.; C C. 53 / ,_ Plan review (25% of permit fee)
�~ State surcharge (12% erf permit fee) , .55 �
Authorized signature: tre 7 _ � i t I. _ W ' o J TOTAL PERMIT FEE..'/ 0. 6 ci
� Pratt name: Im IP' D to i ce / 1 This permit application expires if permit is not obtained within
_• ( 180 days after it bas been accepted as complete.
*Fee md4wihslnav ■ by 'Fri-County Ruildina induciry Service Rosni