Permit CITY OF TIGARD PLUMBING PERMIT
is : COMMUNITY DEVELOPMENT Permit #: PLM2012 -00057
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/15/2012
Parcel: 2S108AB04400
Jurisdiction: Tigard
Site address: 14076 SW 155TH TER
Project: Brentwood Estates, Lot 6 Subdivision: BRENTWOOD ESTATES Lot: 6
Project Description: Backflow preventer for irrigation.
Contractor: FOREST LANDSCAPE INC Owner: ALDER HOMES INC.
3975 NW SUSBAUER RD P.O. BOX 2189
CORNELIUS, OR 97113 TIGARD, OR 97224
PHONE: 503 - 705 -2454
HONE: 503 - 648 -8308
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/15/2012 $31.27
Specifics: 1 12% State Surcharge - 03/15/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 03/15/2012 $41.23
Plumbing
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 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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: _
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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
,<<9 _-
Site Utilities c ei
City of Tigard �� Recei�tid
a 13125 SW Hall Blvd., Tigard, , \ � j J' C. J \� Dac•By: 3 /9 /� - Permit No.: p 0 / C � Id - j �,
C Phone: 503.718.2439 Fax: 50 96 Q� � • Ja
� O \ Plan Bevi°w
Other therPemut No.: /y �p�
T f G ; R [� Inspection Line: 503.639 Q ( ! �J / �� --r) 7l/
Internet wwwligardd- or.gov � .� ® \ � v Due Read e1 1 ®See Page 3 fbr /
Notified/Method: I &rpp a
TYPE OF WORK- _ ;, SCHEDULE •
New construction El Demoliti t For special information use checklist.
Description I Qty. I Ea Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 -family dwel ings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION : - SFR (1) bath 31170
.1- and 2-family dwelling ❑ Commercial/industrial SFR ( bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
El Master builder Each additional bathikitchen 25.02
❑ Other: Fire sprinkler ( sq. ft) Page 2
• JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11_401 (0 Si) 1 SS,: - F ew Catch basin or area drain 18.76
City/StatelZlP: --Ti r i Or d f 1 Drysvell. leach line, or trench drain 18.76
,`J'1 O. Forting drain (no. linear ft: ) Page 2
Suite/bldg./apt no.: I Project name:
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear R: ) Page 2
Storm sewer (no. linear ft: ,) Page 2
Water service (no. linear ft: ) Page 2
Subdivision: I Lot no.: Fixture or Item:
Tax map/parcel no.: Backfow preventer ` 31.27 31. f
. DESCRIPTION OF, WORK . Backwater valve 12.51
Clothes washer 25.02
Y\ -,A71111 1rV , ""ti 111/1 Si Siee.1/1.1 Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
a PROPERTY OWNER 1 • ❑ TENANT Expansion tank 12.51
Name: 71 \Y ay . Olni? S Fixture/sewer cap 25.02
Address: � L._iC��� 5; \. . 1 'ast1t T Floordrain/floor sink� hub 25.02
city /StaterZIP: 1t �, ( ' � U..Are\ OZ. t
Garbage �1 25.02
�` Hose bib 25.02
Phone: ( ) Fax ( ) Ico maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
�
Business name: ) es La ),. ` h c.c. �e. Lc , Medical gas (value: $ ) Page 2
\,�' ('�� Primer 12.51
Contact name: ` 1� z net `s:M*c.. -✓lD Cl
Roof drain (commercial) 12.51
� l 1
Address: .3975 IV ) r �_{
City/State/ZIP: I (� ��r �, q ��' , `� Sink/basin/lavatory 25.02
wr 4 �+�.�ti V� �� q � /� � Solar units (potable wafer) 62.54
Phone: `f) (S+ ) L R_ C� Fmc:: (e w
) (o[ - ' �� Tub/shower /shower pan 12.51
E-mail: A �r J) �+ I Urinal 25.02
• CCONTBACroo
Water closet 25.02
Water heater 37.52
Business name: / V L;, .,r ct,cctp) �WV 56.29
" `-� {�•
Water PiPinF
Address: ,3 t■h; - 5 C\ Other: 25.02
City /StatetZlP 1 YnQ 1 t �,� 0 1Z
g 1 1 t 3 Subtotal 3 .7:1
.
Phone: (C7) 6y B. Ci �a ,� ( ) Minimum permit fee: S72.50 - 72 ,
- "� -14e. L.Ca - C c. W I 6 u L. no.: Plan review (25% of permit fee)
Authorized signature: • e C(. i ( :, State surcharge (12% of permit fee) j l
: Print name:
� -c7 TOTAL PERMIT FEE
L ! At, _ (� Date: - - Z The es permit application expires if a permit b not obtained within 580 days
alter it has been accepted as complete. �j
'Fee methodology set by TriCounty Building Industry Service B
LiBuildifl !c siaPLti1L' 10/01159 40-4616Ttt0/OZ�C0M/WEB) $ e/,
Z 96088ti9£09 edeospuei lseiod eLO :01. Z 6 VI, Jen