Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00228
T ( GA.P D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/09/2012
Parcel: 25101 BB01400
Jurisdiction: Tigard
Site address: 12006 SW GARDEN PL
Project: Park 217 Subdivision: CROW PARK 217 Lot: 2
Project Description: (1) backflow preventer replace and double check
Contractor: POWER PLUMBING CO Owner: WALTON CWOR PARK BC 8 LLC
PO BOX 19418 BY CTMT - WALTON RE TAX
PORTLAND, OR 97280 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE: 503 - 244 -1900 PHONE:
FAX: 503 - 244 -8825
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/09/2012 $31.27
Specifics: 1 12% State Surcharge - 08/09/2012 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment - 08/09/2012 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
•
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: . I p P p t o na , f
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. r C� �
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This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
AUG /09 /2012 /THU 12:16 PM POWER PLUMBING FAX No, 503 244 8825 P. 001
Plumbing Permit ApplicatiETVE
Building 49 2012
) ,OR Ori ICE USE t
• City of Tigard n .infiniall Fame bin.: I 010 4- .190X
13125 SW Hall Blvd., Tigard, OR : , • s F TIGARD Plan Review
' p . Phone: 503.718.2439 Fax: 503 • ' : .' • . B, Other Permit No.:
l . (, h 1 Inspection Line: 503.639.4175 Btu,, I . G D1V1 1 Date Ready/By: I See Page 2 for
Internet: www.tigard -or.gov Notified/144(4. Supplement:) information
r . �' : 1 r i I I ) , j
I x l 1 -:,= : - r - 7 : 1F 7 '7 -7 . , ', , 7' 7 '. \ _ 7h -' 1 \
4 l9( 1 . '- r \
❑ New con$lruction ❑ Demolition For special information ation use checklist
dditiodaitr ration/ lacemeat 0 Description ' ] QN• I Ira. I Total
` ,_ mP New 1- 2-family dwellings (includes 100 R for each utility comiection)
i ' i , 1 y (y.l^ kun' J0 iIC. tt r - ,, . :,' :. SFR(I)bath 312:70
0 1- and 2-family dwelling 17. ommercral/mdustria] SFR (t) bath 437.78
SFR (3) bath 50032
0 Accessory building . ❑ Multi- family
Each additional batMdtchen 25.02
D . it, U' , f,<< -- - ( ,).!:01:',.:!-IV-.,,h. : *,;: - l ; , I Fire sprinkler( sq. ft.) Page 2
Master builder Other:
I .,, ; 'i d I. _ 1 1 1 r . , � f d i S n611t1e9:
Job site address: Catch basin or errs drain 18.76 %
City/State/ZIP: / A Drywall, leach Iine, or trench drain I8.76
I ., Footing drain (no. linear ft,; _) Page 2
Strite/bldg /apt. no.: Project name: P /A SIC al 1 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. l R: - ) Page 2
Storm sewer (no. linear fl,: __,_,_) Page 2
Water service (no. linear ft: ) Page 2
Subdivision: I Lot no.: Fixture or Item:
Tax map /parcel no.: Backflow Clow preventer i 31.27 3i £-
F -- ., , ,,.. I Ui i t c LVi -, 'l a Backwater valve 12.51 •
.::. � t _ - °: j Clothes washer 25.012
/ I " Dishwasher • 25.02
Drinking fountain 25.02
Ejectors/snmp 25.02
I - f Ii ' t lj it „� I { U -; i ........ ;S : 1:7�anSttlmlamit 12.5
Names Fixture/sewer cap 25.02
floor drain/floor sink/hub 25,02
Address: Garbage disposal • 2502
• City/State/ZIP: Hose bib 25.02
Phone: (• ) Fax: ( ) Ice maker 12.51
k - 11 , .''..!.]:1, { 1i`itl t� ( '>��f'(r�C t i '�!,' 1 (•),I 1 Interceptor/greasetrap 25.02
! ► / Medical gas (velum $ ) Page 2
Business nano:
11j ,_ LL11L Primer 12.51
_
Contact name: • fy lM Roof dra n commercial 12.51 .
Address: •• -• - - -•- - -- - ._.._�...- - - .._.. -• -• - -•- --- •-- ..- .__..._
Smk/basmfiavetory 25.02 - - -
C ity /Sl,.:.•:.,:..::::_.:- - ,::.._,.,.... 1(_ - <= �5:= . .. .__. _ ..._..Solar, units ;(potablesveter),.- :...:.:....- .....� .__6264_ ..:._..... -_- ...
_ phone:.( .... ). / ...._'7.1A . . .. .F a x ;.( ..).2, ■ .. Tub/slrower /showerptn 12.51 ...
Emiaik
Urinal 25.02
a r -- : .r, c. •: - , r, , 1 Water closet 25.02
. - - =�.- -- •- - - - == ---- •-- -- - =' -. �•, }
.._..: _. . ,. • • . , .. Water heater 37.52
Business name: • _ _' _ f Water piping/DWV 5629
Address: - /,, _ -�_ -. Other 25.02
City /State/ZIP: ("-4 T Subtotal 31 1.7 - 1
hone: ( ) • Pax ( ) Minimum permit fee: $72_50 -12.50
r 52.52.,./ Plan review (25% of permit fee)
CCB Lic.: � Plumbing Lie. no.: .§4--)5D State surcharge (12% of permit fee) ( 10
Authorized signature: TOTAL PERMIT FEE i Z 0
This p ermit a expires ire permit is not obtained within 180 days
after Print name: �J! f ale � _Date: g�I it bin beim accepted as complete
*Fee methodology set by T$ - Cowity adding Industry Service Board
ins: fail/no 440.9616T otoveo � .. 1 id1781PerrniisTPLMu-rataltnop.tiog