Permit I
CITY OF TIGARD PLUMBING PERMIT
14 . COMMUNITY DEVELOPMENT Permit #: PLM2009 -00182
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/10/2009
:TIGARD ; g Parcel: 2S 103 DA05900
Jurisdiction: Tigard
Site address: 10590 SW COOK LN
Subdivision: Lot: 0
Project: Bishop
Project Description: Installation of residential backflow preventer for irrigation system.
Owner: FEES
BISHOP, WILBUR A AND MARTHA E Quantity Description Date Amount
PO BOX 23832
TIGARD, OR 97281 1 ea Backflow Prevention - RES 07/10/2009 $27.55
PHONE: 1 12% State Surcharge - 07/10/2009 $4.35
Plumbing
9 ea Minimum Fee Adjustment - 07/10/2009 $8.70
Contractor: Plumbing
DOWN TO EARTH IRRIGATION
402 BEAVERCREEK RD STE 106
OREGON CI TY, OR 97045
PHONE: 503 - 723 -6212
FAX: 503 - 723 -6244
Type of Use: SF
Class of Work: OTR 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 Nofification ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or d ct questions to c . g 503.246.6699 or 1.800.332.2344.
I ued By: L_ Permittee Signature: f
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.
• Plumbing Permit Application
Building Fixtures ��
City of Tigard ECEV R eceived .7 to 0 9 �O /g).... r�
Date/By: Permit No.: alb/) /
® 13125 SW Hall Blvd, Tigard, OR 9 223
Plan Review
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' 0 : Phone: 503.639.4171 Fax: 503.598.1 1 0 ZOOS Date/By: Other Permit No.:
T 1 G A R p Inspection Line: 503.639.4175 Date Ready/
By: www.tigard-or.gov y' r @ 0 See Page 2 for
T V OF TIGARD Notified/Method: v.4' Supplemental Information
TYPE OF W DING DIVISION FEE* SCHEDULE
New construction Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
(g 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I x-�'� I v (I. `'"'t - 141 - Catch basin or area drain 16.60
City /State /ZIP: -.. CAO, y( 1 C V , q /z7, Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: � " I Project name: IATb '�) D p Footing drain (no. linear ft.: _J Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _J Page 2
Storm sewer (no. linear ft.: Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
1 - 0 lI�n9 a ir� ( rrrw ► J � I vt C
�j� y' Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER] TENANT
Drinking fountain 16.60
Ejectors /sump 16.60
Name: 1(S _/-0 Expansion tank 16.60
Address: ) 0 C o 0 () 00K, Fixture /sewer cap 16.60
City/State /ZIP: i Y j (�}� q-77-3-----
Floor drain/floor sink/hub 16.60
Phone: Mb) (17-4t Fax: (305) 70 s -- (40.2./ Garbage disposal 16.60
g APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: 1 "C) 117 l irriTI-xyq
c '/� �j � Q , C � r��l)rl Interceptor /grease trap 16.60
Contact name: Ch rI ( I Y Ili to v Medical gas (value: $ ) Page 2
Address: Li a .61 v (�C �/ i il�(..� r 5,%, J% Primer 16.60
City/State /ZIP: (Ji' Cr i d' . Q70y15 Roof drain(commercial) 16.60
Phone: ( )1� - l z, 7 I Fax : : ( SZ 3) 72. 0 2.4ry Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E - mail:
Urinal 16.60
` CONTRACTOR Water closet 16.60
Business name: y�'7,, � � ) //,yl ' / ( C 1 Water heater 16.60
Address: L/ O ^ d NJ'� �} (U q rV � /Z D f , 1 rc4 . / 06 Other:
City/State /ZIP: O -(. (')n CAtii 1 CV 7015 Subtotal
Minimum permit fee: $72.50
Phone: (5)Z) 72 Z/ Fax: (9)-3 7Z5 - Z J ZZ. Residential backflow minimum permit fee: $36.25 �
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) • 5
Authorized signature: perm
. M /
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TOTAL PERMIT FEE I / � Q
I Print name: c ot; 1/u Se�//�/ Date: 7/9 /on This permit application expires if a permit is not obtained within
l • 180 days after it has been accepted as complete.