Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00181
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/10/2009
Parcel: 2S102AA05000
Jurisdiction: Tigard
Site address: 12290 SW MAIN ST
Subdivision: Lot: 0
Project: Bishop
Project Description: Installation of commercial backflow preventer for irrigation system.
Owner: FEES
BISHOP, MARTHA E & Quantity Description Date Amount
BISHOP CHILDREN'S TRUST, PO BOX 23832
TIGARD, OR 97281 1 ea Backflow Prevention - 07/10/2009 $46.40
COM
PHONE: 1 12% State Surcharge - 07/10/2009 $8.70
Plumbing
26 ea Minimum Fee Adjustment - 07/10/2009 $26.10
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: COM
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 Notific • en . hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct estions to OUNC by calli :.03.246.6699 or 1.800.332.2344.
Issue By: L. / // / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an Inspection that busi 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.
PktinbinQ Permit Aaalicatio ECEIVED
Building Fixtures
i City of Tigard JUL 10 2009 Received
13125 of Hall Blvd., Tigard, OR 972 Date/B /d dg , Permit No. L/ ( _ _ (�t'e I
• 11 11 I Plan Review
Phone: 503.639.4171 Fax: 503.5ill OF TIGARD Date/By: Other Permit No.:
. _ A R n Inspection Line: 503.639.4175 obi DING DIVISION Date Ready/By: kris: H See Page 2 for
Internet: www.tigard -or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
1 4 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
❑ 1- and 2- family dwelling 051 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/ldtchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 72C 0 NO P 1 n Catch basin or area drain 16.60
City/State /ZIP: I ! OJU id V V , gl a Drywell, leach line, or trench drain 16.60
-
Suite/bldg./apt no.: J 1 Project name: ;I% 1) ' 1 s ?'.i a Cl V ".(r`an 6ifyhcp Footing drain (no. linear ft.: _) Page 2
V Manufactured home utilities 110.00
Cross stmet/directions to job site:
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
Tax map /parcel no.:
Fixture or item
Absorption valve
1
DESCRIPTION OF WORK � Backflow preventer Page 2
l /� l I0i ( nt , c pr (r /1Ww sy --71. h Backwater valve 16.60 J
V Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Name: / i an b h p Ejeciors/sump 16.60
`, + � Expansion tank 16,60
Address: I ZZQ 0 l �I )u M i fl 5 f • Fixture /sewer cap 16.60
is
City/State/ZIP: (I Oyi. rd. OF. 7 g Floor drain/floor sink/hub 16.60
Phone: (5O '5) 91 (O5 Fax: ( ) Garbage disposal 16.60
Cif APPLICANT I ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: g)uin -b Corm m rr a1ier Interceptor /grease trap 16.60
Contact name: r I wi rii, wooly Medical gas (value: $ ) Page 2
Address: Hoz cr
amree(G tt I Do Primer 16.60
City/State /ZIP: r On ci f )' . q 7y Roof drain (commercial) 16.60
Phone: (565) 72 1-- (p z / I Fax: : 605 ) 72 5--0 Z 1,/ Sink/basin/lavatory 16.60
E -mail Tub /shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: f T � r I 1 0 � la ft heater 16.60
Address: I )7, P. ,1eraety y 1 e- 101* Other:
City/State/ZIP: O C jr l)V • A>is Subtotal
Phone: 1' 011 7) I � , / 6 �� i Min permit fee $72.50 �
Fax: � ) 775 i Residential backflow minimum permit fee: $36.25 p�
CCB Lic.: W(at3l f /f 1 f () Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (12% of permit fee) g
TOTAL PERMIT FEE g i . a
I Print name: ClI'frsii' ( i 1 sc I Date: 7 /Q /6 I This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.