Permit CITY OF TIGARD PLUMBING PERMIT
I 8 : COMMUNITY DEVELOPMENT Permit #: PLM2009 -00275
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009
Parcel: 2S105DD06000
Jurisdiction: Tigard
Site address: 13595 SW SANDRIDGE DR
Subdivision: Lot: 0
Project: Stuhr
Project Description: Install backflow device.
Owner: FEES
STUHR, GWEN Quantity Description Date Amount
13595 SW SANDRIDGE DR 1 ea Backflow Preventer 10/02/2009 $31.27
TIGARD, OR 97223 1 12% State Surcharge - 10/02/2009 $8.70
PHONE: Plumbing
41 ea Minimum Fee Adjustment - 10/02/2009 $41.23
Contractor: Plumbing
JOHN DARBY LANDSCAPE INC
13867 SW BENCHVIEW TERRACE
TIGARD, OR 97223
PHONE: 503 - 579 -5298
FAX: 503 - 524 -6613
Type of Use: SF
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: .1 ` 1 JlA Permittee Signature: \
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.
Oct 01,09)0 :31a John Darby Landscape (503)524 -6613 p.3
Plumbing Permit Anvil CEWED •
Building Fixtures FOR OFFICE USE ONLY
City of Tigard ocT o 1 2009 Permit No.: n4zbpq - ocg?7s
1111 il 1 3125 SW Hall Blvd., Tigard, OR 97223 Plum AVACW
Phone: 503.639.4171 Fax S QL Other Permit No.:
. Inspection Line: 503.639.4175 TIGIDY .
T t `. " "I) burner: www tig�-orgov BUILDING DIVISION No I Supplemental „�, •
•
.. TYPE OF WORK . .. S i�DU E
❑ New construction ❑ Demolition For special irrformtaton use checklist
)gtAddition/alterationfteplaccment Description 1 Qty. 1 Ea I Total
❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Z/,
1- and 2- family dwelling ❑ Con
nr»ercial/indtrstttial SFR (2) bath 350.00
Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
Q Master builder ❑ Other.
Fire sprinkler (____ sq. ft) Page 2
JOB Sft INFORMATION AND LOCATION Site utilities
Job site address: 1 '3595 810 fib rids ' \C Catch basin or area drain 16.60
City/State/ZIP: *- 1 4 1 (' � t OT._. . 17221 ��� 111 Dryweil, leach line, or trench drain . 16.60
SuitelbldgJapt. no.: , � ` •I Protect nHama / Footing drain linear ft: _ - Page 2
Manufactured home utilities 110.00
Cross street/Erections to job site: '
Manholes • 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear It: ) Page 2
Storm sewer (no. linear ft.: _J Page 2
Subdivision: • I Lert no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
• DESCItTPTTO OF WORK
��y�' Badcflow pm-valid Page 2
,* ii QI93 p ' "vl Backwater valve 16.60
l `O r r " 1 Clothes washer 16.60 •
e�1 Dishwasher 16.60
❑ PROPERTY OWNER . •I ..... . 0 TENAN .. Drinking fountain 16.60 mt Ejectors/sup 16.60
.j�(
Name: G, `�'�`�,, ( _Expansion tank 16.60
Address: '1; ' 1 ,. i y 1 i Fixture/sewer cap 16.60
City/StatelZIP: yykli:r\ i P 7. , . it Floor drain/floor sinkPonb 16.60
Phone: ( ) 1 Far ( ) Garbage disposal 16.60
❑. APPLICANT - - 0. CONTACT PERSON Hose bib 16.60
ke maker 16.60
Business name: cithiy jay) ~ (�, Interceptor/grease trap I 16.60
Contact name: V W ► a'iry�. J / 4 V l &)� Medical gas (value: S ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: ( ) Sink/basin/lavatory 16.60
Tub/shower /shower pan - . 16.60
E -mail: Urinal 16.60
. NIRA crOR . . . • Water doses 16.60
Business Haute: rr l 4 •, , • A Water heater 1660
Other
Address: d 1 t." 'I. it 1 .. 1 '1 . ha
-
City/State/ZIP: r i .► � _t. , �1' Subtotal
- -
4 - •,�"'1wLNiI x�� M inirtnunperm i tfee: 536.25
Phone:, $
Reside ntial badmow minimum permit fee: 536.25
CCB Lie.: + Plumbing Inc. no.: Plan review (25% of permit fee)
Authorized signature: _ - _ State surcharge (12% of permit fee)
TOTAL PERMIT FEE f,
1 Pratt name: ISM a k ►_,/ . G I : y t This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
U ` . 3 Q • C) 9 •Fee methodology set by Tri .County Building Industry Service Board.
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