Permit .
CITY OF TIGARD PLUMBING PERMIT
' -- COMMUNITY DEVELOPMENT Permit #: PLM2009 -00260
;TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 09/22/2009
Parcel: 1S135BC01100
Jurisdiction: Tigard
Site address: 11101 SW GREENBURG RD
Subdivision: Lot: 0
Project: Greenburg Building
Project Description: Installation of commercial backflow preventer for irrigation system.
Owner: FEES
ROBINSON FAMILY TRUST Quantity Description Date Amount
PO BOX 91305
PORTLAND, OR 97291 1 ea Backflow Prevention - 09/22/2009 $46.40
COM
PHONE: 1 12% State Surcharge - 09/22/2009 $8.70
Plumbing
26 ea Minimum Fee Adjustment - 09/22/2009 $26.10
Contractor: Plumbing
PACIFIC LANDSCAPE
PO BOX 1155
HILLSBORO, OR 97123
PHONE: 503 - 648 -3900
FAX:
Type of Use: COM
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 Cedes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not sta ed ithin 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rul s a. opted by the Oregon
Utility i ication C nr. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You ma ob l: in a copy of the rule
or d' ecf t q uestions to OUtJ by . ling 503.246.6699 or 1.800.332.2344.
Issd By: I • /�, Permittee Signature:
_.i • „ v.
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.
,_Pakibing Permit Application
Building Fixtures RECEVEI . .
FOR.. OFFICE USE ONLY,' .
City of Tigard Received 1� Permit No.: P ,
Iii 13125 SW Hall Blvd., Tigard, OR 97223 SEP 2 2 2009 Date/By: : t 7 eK C.GI'/ �D9�
Phone: 503.639.4171 Fax: 503.598.1960
Plan Review
"' " � ' ' Other Permit No..
Date/By:
Inspection Line: 503.639.4175 CITY OF TIGARD
T IGAR' , D D ate ReadyBy: Ju ns: ® See P age 2 for
Internet: w w. tigard -ocgov BUILDING niVISION Notified/Method. / Supplemental Information
TYPE OFWORK , . 'FEE* SCHEDULE
Z New construction ❑ Demolition 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)
e ° , CAT.EGQRY O'F' CONSTRUCTION ' ; - , , SFR (I) bath 249.20
❑ 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
u JOB` SITE INFORMATIO OD LOCATION -
� r x. = . - . , . Site utilities
Job site address: 11101 SW Greenburg Road Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Greenburg Road Project Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Greenburg Road & SW Tiedeman Road
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION ., O WOR
h , ' .,,,, Backflow preventer I Page 2 46.40
Install backflow prevention device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
0 PROPERTY OWNER _ - ' ❑° TENANT ., - -
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
® APPLICANT . _- • 1:1:. CONTACT PERSON
-° Ice maker 16.60
Business name: Pacific Landscape Management Interceptor /grease trap 16.60
Contact name: Kelly Crouch Medical gas (value: $ ) Page 2
Address: 21555 NW Amberwood Drive Primer 16.60
City /State /ZIP: Hillsboro, OR 97124 Roof drain (commercial) 16.60
Phone: (503) 648 - 3900 Fax: : (503) 642 - 2369 Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
. CONTRACTOR Water closet 16.60
Business name: SAME AS LISTED ABOVE Water heater 16.60
Address: Other:
Subtotal 46.40
City /State /ZIP:
Minimum permit fee: $72.50 ?� 50 ufra
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 7318 4 1 ! Plumbing Lic. no.: 14252
Plan review (25% of permit fee) .4).- pkr
Authorized signature: � State surcharge (12% of permit fee) $ ;7�5.5(s r
TOTAL PERMIT FEE �i.Agh9'6
Print name: Kelly Crouch Date: 09/21/2009 This permit application expires if a permit is not obtained wi •
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service ard.
I:\Bu ]ding \Permits \PLMF - PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB)