Permit CITY OF TIGARD PLUMBING PERMIT
$ COMMUNITY DEVELOPMENT Permit #: PLM2012 -00084
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/13/2012
Parcel: 2S105DD05800
Jurisdiction: Tigard
Site address: 13645 SW SANDRIDGE DR
Project: Stanley Subdivision: PACIFIC CREST Lot: 34
Project Description: Installation of backflow preventer for irrigation.
Contractor: SOUTHWEST LANDSCAPE LLC Owner: STANLEY, GARREN J &
8900 SW BURNHAM ST E -108 BENNETT, CHRISTOPHER B
TIGARD, OR 97223 13645 SW SANDRIDGE DR
TIGARD, OR 97223
PHONE: 503 - 620 -0149 PHONE:
FAX: 503 - 620 -0590
FEES
Quantity Description Date Amount
ea Backflow Preventer 04 /13/2012 $31.27
Specifics: 1 12% State Surcharge - 04/13/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 04/13/2012 $41.23
Plumbing
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 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 que OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: areit4tt,tki Permittee Signatur .
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.
04/07/2012 13:23 FAX 21001/002
RECEIVED -
Plumbing Permit Application APR 9 2012 FOR OFFICE USE ONLY
City of Tigard Received -
_
Dat R : y 4 /'t ) Permit No.: [. l f i0l a'! • '0.08
v 13125 SW Nall Blvd., Tigard, OR 97223 I'�/ Qj+ �TI GARD . � Review
Phone: 503.639.4171 Fax: 503.598.
Inspection Line: 503.639.4175 13 ILDING DIVISI • + ia� _o Permit No„
TIGARD
Internet www•ugard- or.gov ��eReady /By: haiz ®ycs Pre 2for
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I:1 New construction .. h -
❑ Demolition Far�cCialinjarnra6on use checklist.
ID ( Addition/alteration/replacement ther. Description Qty. Ea. Total
: > C .., .. _
New 2 (includes 100 R for each utility connection)
:...
...__.;.. . . ..: ..
..:. _,:• A TEOORY ,O.F
.... , , . SFR l bath 24920
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
1=1 Accessory building ❑ Multi - family SFR (3) bath _ 399.00
ID Master builder ❑ Other Each additional bath/kitchen 45.00
;...:.:,. )
_:...... s : .. '..: :... Pace 2
=; ORMATI .AND:':L
Job site address: - . 71 • i, 4,, , c ,', - Dr- Catch basin or area drain 16.60
City / state/ZIP_ �,C c ., 4 .--. r� c ` �1 —
, Drywcll, leach line, or trench drain 16.60
Suite/bldg./ apt. no.: Project , � � \ � ` Footing drain (no- ling R: _) 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: ' j Lot no.: Water service (no. linear ft : Page 2
Tax map /parcel no.: Firm re or item •
... Absorption valve 16.60
.::
Rlf,'.17:fgi,:OF -'..W - Backflow preventer I Page 2
ii,l Y : i f B 4 Backwater valve 16.60
/ A Clothes washer 16.60
D 16.60
i:' )`;PROPER '- I -,_: ..:. -- fountain `
.. Tl :`14#I# - -;- = :' 16,60 —
E ectorsl
Name: e-, -- � .'� J P 16,60 `
Address: \ � _ L.( ` Expansion tank 16,60
~ �C. C Fi:tumJsewercaP 16.60
City/ State/ZIP , � ( 7 J •"1)D -3 _Floor drain/floor sink/hub . 16.60
Phone: ( ) F ax: ( •) Garbage disposal 16.60
;APPLIICMn
Business name. ,\ � lectnaer _ 16.60
-1 \, e-4-,\— w -,�r, Interceptor /grease trap • 16.60
Contact name: ��
--, Medical gas (value: 3 ) Page 2
Address: �(�' , ,CN - 4 1 y, C1 , ... �� • cL_ Prim _ 16.60
City /St ate/ZIPt'� � \ L 4-7� Roof drain (commercial) 16.60
Phone: no-'1 t� — C \L \t:� I Fax: :( ) Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan 16,60 ,
Urinal 16.60
- .. -:. ...:... �: :::!:_.r Water closet 16.60
Business name: ' �^ Water heater 16.60
Address: , fli
City/State/ZIP: Subtotal
Phone: ( ) Minimum permit fee; 572.50 72
Fax: ( ) Residential backflow minimum permit fee: 536.25
CCB Lie.: gL 4/Ao /3 Plumbing Lic. no.: Plan review (25% of permit fee) ■—,
Authorized sigmaturc: / � State surcharge (8 %ofpermit fee) g 7 0
4' / TOTAL PERMIT FEE C I •
Print name: 110. • Date: 6— \D._ 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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