Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00252
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/29/2012
Parcel: 1S125DC06900
Jurisdiction: Tigard
Site address: 7169 SW ASH CREEK CT
Project: Joerger Subdivision: ASH CREEK ESTATES Lot: 2
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: ARTISTIC LANDSCAPES Owner: JOERGER, JAMES H & CATHY J
10670 SW BLACK DIAMOND WAY 7169 SW ASH CREEK CT
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 892 -6315 PHONE: 503-477-5761
FAX: 503 - 620 -6901
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/29/2012 $31.27
Specifics: 1 12% State Surcharge - 08/29/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 08/29/2012 $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, j / 1987 or 1.800.332.2344. /1��, f
Issued By: Permittee Signature: 01 ` n t 1 �--i` /}- - 01
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. tT
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 29 12 12:29p p.2
Plumbing Permit Applic r i. ,
Building Fixtures 2 9 2012
� + � ticd
City of Tigard Q �,r, �pD Dat Rcc e/ ci By 8 al 1 A k P NO' - �0�0 %9-2
a 13125 SW Hall Bhd., Tigard, OR 5�M it 1't A
Phone: 503.718.2439 Fax: 503. Plan Review ��1
S� Date/By Other Permit No.:
T I G A R D y. kris Inspection Line: 503.639.4175 n { {1` ®�� Date Ready/By. M See Page 2 for
Internet: www. tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
y Addition/alteration/replacemcnt ❑ Other: New I- 2-family dwellings (includes 10011. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
Al- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437,78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
•
Job site address. 7 j(po S (.0 C Q � CT. Catch basin or area drain 18.76
Ty' i G --+7 of= 9- as 3 Drywell, leach line, or trench dram 18.76
Ci State/ZIP: `T
Fooling drain (no. linear ft.: __) Page 2
Suite/bldg. /apt- no.: I Project name: J g.C)f.. g, Manufactured home utilities 50.03 ;
Cross street/directions to job site: Manholes 18.76
X Se: S tk.) C V D y P L- Rain drain connector 18.76 '
1
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear fL: _J Page 2
Water service (no. linear ft.: ____.) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer j 31.27 3j . di
DESCRIPTION OF WORK Back valve 12.51
Clothes washer 25.02
. if\ 1 12tt i(1 CIF- i za -) eve nin n Dishwasher 25.02
1JC.JI Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I ❑TENANT Expansion tank 12.51
Name: , j p E. ( tt _
Fixture/sewer oo cap 25.02
Floor drain/floor sink/hub 25.02
Address: - 11 (p 9 s, As , Ct t . cT Garbage disposal 25.02
City /State/ZIP: --fl C -(Z1) O � c'►a -a3 Hose bib 25.02
Phone: (�)
H -'f-j 61 ( D I Fax: ( ) Ice maker 1? 51
Interceptor/grease trap 25.02
,APPLICANT ❑CONTACT PERSON
Business name: p L j0 7ipE 5
Printer M � gas (value: $ ) P 12. 2
12.51
Contact name: of t o T KA PS
Roof drain (commercial) 12.51
Address: E 113 c5i,t.) 43.ZLC B1 I/Yl0t( .4 L ...L 1 Sink/basin/lavatory 25.02
City /State/ZIP: 1 1 O ya l
01e- _- aa-3 Solar units (potable water) 62.54
Phone: (5C3) SS 1 l s- Fax : ( ) (,2 ZG -(9901 Tub / shower /shower pan 12.51
• E -mail: kOKc.e..� G 1S�cmn 064keEspi)x • CUM Urinal 25
Water closet 25.02
CONTRACTOR
Water heater 37.52
• Business name: Agri 711C> Q C)\1 Z(- Water piping/DWV 56.29
Address: 1 t)(o1 S
C) -SiAD lcicL 0t.7ttn'1(:. (pct uzz. --a- Other 25.02
City /State2lP: - r' 6) v-A 1 c G -- iaa-3 1 Subtotal ;31. ....7
l� ) ' .' (D5 (S 3 f 3t 'f. Fax: (r, )3) (0 - 6c 90
Minimum permit f $72
Phone: ( 50
CCB Lie.: f 4 * - Plumbing Lie, no.: Plan review (25% of permit fee)
j State surcharge (12% of permit fee)
Authorized signature. KJ) %G /7 TOTAL PERMIT FEE 7 . V1 'This permit applicatiafter on it ecpires if bee a a ote permi p ted m cot m not obtained within 180 days • Print name: (.i( !- ` -rt (�{
Date: g / Z has rn
t J
*Fee methodology set by Tri- County Building Industry Service Boar . /
1: 1BuildingWcrm its 1 ?LMU- VmritApp.dac :■01F)9 440- 4616T(10AO2/COMA4F2)
Aug 291212:29p p.1
Artistic Landscapes
FAX TRANSMITTAL
DATE: 8 -29 -12
City of Tigard Building Sarah Kinsey
TO: Permits FROM: Office Manager
FAX: 503 - 598 -1960 FAX 503 - 620 -6901
TEL: 503- 718 -2439 TEL: 503 -892 -6315
CC: PAGES: 3 (including cover page)
COMMENTS:
Hello,
We need a backfiow permit for the attached jobsite. Please fax back permit and
receipt to 503 -620 -6901.
Thank you,
Sarah Kinsey
Office manager
Artistic Landscapes
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00252
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/29/2012
Parcel: 1S125DC06900
Jurisdiction: Tigard
Site address: 7169 SW ASH CREEK CT
Project: Joerger Subdivision: ASH CREEK ESTATES Lot: 2
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: ARTISTIC LANDSCAPES Owner: JOERGER, JAMES H & CATHY J
10670 SW BLACK DIAMOND WAY 7169 SW ASH CREEK CT
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 892 -6315 PHONE: 503-477-5761
FAX: 503 - 620 -6901
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/29/2012 $31.27
Specifics: 1 12% State Surcharge - 08/29/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 08/29/2012 $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, j / 1987 or 1.800.332.2344. /1��, f
Issued By: Permittee Signature: 01 ` n t 1 �--i` /}- - 01
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. tT
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.