Permit .)
u CITY OF TIGARD PLUMBING PERMIT
a. ' COMMUNITY DEVELOPMENT Permit #: PLM2009 -00202
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/27/2009
Parcel: 1 S135ACO2500
Jurisdiction: Tigard
Site address: 9392 SW MANDAMUS CT
Subdivision: LONGSTAFF CONDOMINIUMS Lot: 19
Project: Lonstaff Condominiums
Project Description: Install backflow device.
Owner: FEES
CASA TERRA LLC Quantity Description Date Amount
BY ALPHA COMMUNITY DEVELOPMENT, PO
BOX 1082 1 ea Backflow Prevention - 07/27/2009 $46.40
COM
PHONE: 1 12% State Surcharge - 07/27/2009 $8.70
Plumbing
26 ea Minimum Fee Adjustment - 07/27/2009 $26.10
Contractor: Plumbing
ANCTIL PLUMBING INC.
16900 SW MERLO ROAD
BEAVERTON, OR 97006 -0000
PHONE: 503 - 642 -7323 •
FAX:' 503 - 642 -7755
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Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
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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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: Permittee Signature: �n I „. � ___ c_._ (k cLua.,e_ >k s.a. L__ '
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. (D1.911)..
J�J 11111Yyy ���%%���//�VVVLLL DA.
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.
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1 r
.Ph{imbing Permit Application ?-3"56
. Building Fixtures
City of Tigard CEIVED Received
I A IlEarnriZPM
paten , 4 13125 SW Hal1131vd., Tigard, OR 9
Plea Review
■ Phone: 503.639.4171 Pax: 503.598.1960 • . Date/By: Other Permit No.;
- r i C; E.13 Inspection Line: 503.639.4175 2 3.2009 Date R
Internet www.ti and -or. ov �u` �v; r�^�; Ea See Page 2 for
g g Notified/Method:
r (C Supphenirogal lnrormauoa
TYPE OF wo ' , . Ni OF ' " - N FEE* SCIIEED
❑New construction [VI,' �, , a For . dat ' ormation use clrecklirL
Descri , ;on i M Ea. Total
F i • 'tiorl/alteration/replacemeat 0 Other:
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION . . SFR (1) bath 24920
❑ 1• and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
D Accessory building Wulti- family SFR (3) bath 399.00
Each additional batb/ldtchen 45,00
❑ Master builder ❑ Other:
Fire sprinkler (_ sq. ft) Page 2
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JOB SITE INFORMATION AND LOCATION Site utilities
Job site address a a L 6111-0 I9 i g V J5 ()4,f Catch basin or area drain 16.60
City/State/ZIP: Drywall, leach line, or trench drain 16.60
Suite/b1dg. /apt. no.: Project name: Footing drain (no. linear ft.: Page 2
Manutltetured home utilities I= 110;00
Cross street/directions to job site: �� gMta •
Manholes 16.60
• Rain drain connector 16.60
Sanitary sewer (no. linear R: Page 2
Storm sewer (no. linear ft.: _
Subdivision Lot no.: Water service (no, linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
• Absorption valve 16.60
DESCRIPTION OF WORK . BacicBow preventer - --
4C cg " ■ I L . 1 • Backwater valve 16.60
_±.1 A• c (Ale? 5 Clothes washer 16.60
Dishwasher 16.60
".` ' OPERTY OWNER : ❑ 'TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: ? C I L/ E _
► /4/4- /4/4- Address: Expansion tank 16.60
C/ ! /t. +� l . Fixture/sewer cap 16.60
City/State/EP; r A i i j 4. 4- 3 Floor drain/floor sink/hub 16.60
Phone: ( ) • Fa ( ) Garbage disposal 16.60
❑ APPLICANT . ❑ CONTACT PERSON Hose bib 16.60 .
Business name:
Ice maker 16.60
Interceptor /grease trap T 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/Z2: Roof drain (commercial) 16.60. •
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan • 16.60
E -mail: _
Urinal 16.60
CONTRACTOR Water closet 16.60
• Business name: r W C 1 • C. t I.. vrri • t Nf _ Aic.. 'Water heater 16.60
Address: all Q d µ1 /7 E CO Z D . Other.
City/State/ZIP: 0 V • L° • p G Subtotal
Phone: (5b3 (o Z Z.'JJ Fax: ( Minimum permit fee: $72.50 �/
� 3, ' • Z' 1-4,55' R es id en t ial bacl�ow m i n i m u m .. fee: S36.25 C.'
CCB Lic.: 2. i $ Plumbing Lic...:iiir ~ I (p 4 P; Plan review (25% of permit tee)
Authorized signature: '- State surcharge (12% of permit fee) Q.. •
TOTAL PERMIT FEE
Print name: 3. L.L A uC i- i- Date?-.--22 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.
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