Permit 111 -kCITY OF TIGARD PLUMBING PERMIT
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F `COMMUNITY DEVELOPMENT Permit #: PLM2012 -00296
TIGARD • 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/15/2012
Parcel: 251100009100
• Jurisdiction: Tigard
Site address: • 15850 SW HIGHLAND CT _
Project Stewart Subdivision: SUMMERFIELD NO.6 Lot: 307
Project Description: (1) backflow preventer installation
Contractor: OWNER Owner: STEWART, PAULA L
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15850 SW HIGHLAND CT
TIGARD, OR 97224
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PHONE:
PHONE: 503 - 880 -9381
FAX:
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FEES•
Quantity Description Date Amount
1 ea Backflow Preventer 10/15/2012 $31.27
Specifics: 1 .12% State Surcharge - 10/15/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 10/15/2012 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
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• Total $81:.20
Required Items and Reports (Conditions)
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• T subject e, State of R. Specialty Codes and all other •
applicable his permit law. is. issued All work will be to done the in regulations accordance with approved in the plans. Tigard This Municipal 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
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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
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or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. •
Issued By: ' � P� , Permittee Signature: Oh. ( A R /� /1 77 ` I
� Oy �l /fit, t' �(� L I �t M
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.
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FROM (MON)OCT 15 2012 8:25/ST. 8: 24 /No. 7518784817 P 1
Plumbic P ermit Application a
Site Utilities L. l a •c, ( W c . ��
Utli
1f I IZ )III I . I I . ( I .l
City of Tigard OCT 15 2 012 Received Petm itNo.: gp�
. 13125 SW Hall Blvd., Tigard, OR 97223 Date/ (01 f Sj1.. p � a �Od A.14,
• Phone: 503.718.2439 V
439 Fax: 503.598.1960 /1�'�
OF T• • • 1 DatelBy. Plan Review Other Permit No.:
Inspection Line: 503.639.4175
I t f Vf
TI GAR(7 Ready /By:
Internet: 7 " 1 See OPage 2 Internet: www.ttgard- or.gov BUILDING o � ��
: �' '� t �\ tified/M ' J'O trOentd {aformapoo
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For special information use checklist.
N ew construction
❑ ❑ De molition
�..�( . r Description I Qty. I Ea. I Total
El Addition /alteration /replacement 1 .l Other: 112 ___ ��' 111 l 0 )Y New 1- 2- family dwellings (includes 100 ft. for each utility connection)
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rEir- ..: fit: -s.. c _ v.:w w..� . a ' a ;
` ^iR',..Ci :Sr = '' - �`== ' 4 CA 1F `tJ k g a. -'N ii SFR (I) bath 312.70
^� t � b��l'i�(. l:, Ctf?y1M.� C.lb`
jig l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 _
Accessory building SFR (3) bath 500.32
❑ ry g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
uk::'.:.a 4:::17,-1'‘, '- k'�'.. �... t..i.r:u,.- 4i'a .
1.; �ndu��vy�.i tl .+6.r: -se `.f•:r, .� � M'f - Fv_;
Site utilities:
^;: , ,%>uc$. ; i c• • Mfi . o a - a_ r: n ` - , "a,. -_ ' 'i
Job site address: i cl - ct) i Grp.- t et, Catch basin or area drain 18.76
City /State/ZIP: -''t d` 6r 95,244 Footing drain ( line, or trench drain Page 2
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03 ^
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Cross street /directions to job site: Manholes _ 18.76
i kl f _ h �� n f 0 Rain d rain connector 18.76
1J( j l � 4 Sanitary sewer (no. linear ft.: _) 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.: Backflow preventer V 31.27
° i;^'`' . *,t, - r - -5 + �' , .,.�1 water va lve 12.51
,:.k .,�,' �y "'i<'..,- �� 1 Back
Clothes washer 25.02
' Dishwasher 25.02
Drinking fountain 25.02
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Ejectors/sump 25.02
` '`-` `" '`t ti- '`� !41. - a:J& • t = igii4J i"''„ Expansion tank 12.51
Fixture/sewer cap 25.92
,,,,, Name: 5f. J Yew
j _ � ' �,) � �/ � / l Floor drain/floor sink/hub 25.02
Address:
L �o 5 ✓. 14.-t �`r lt�� -^A of Garbage disposal 25.02
City / State/ZIP: /7 _f,,,S, V /7,r q /7.44 Hose bib 25.02
Phone: ( SUS) • p en , . - 1 q Fax: ( ) Ice maker 12.51
,�, } -� .,.: 1 -,. Y , . ;fi t f: 2� (` Y�i - - _ -:. ,-*,-- ,,,,:n - 1 . 4 4 -:, '.:'.
!hl a
s " ial _ _ , Interceptor /grease trap 25.02
• Business name: Medical gas (value: $ ) Page2
Primer 12.51 •
Contact name:
�� Roof drain (commercial) 12.51
Address: ` Sink/basin/lavatury 25.02
City /State/ZIP: / Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub/shower /shower pan 12.51
E-mail:
Urinal 25.02
R {.� . •;.w:'r.'; , -. c z)y...r:;: w Water closet 25.02
"."i:•m..' s 1 :z ..l:r.0:5:i '__ ,r "' ,,iri ;;' .. -: _� ' ,:, 't
' ir- F ; .i. Watts heater
37.52
Business name:
Water piping/D W V 56.29
Address: Other: 25.02
City / State/ZIP: S
f
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nmum permit $72. 1 2
Phone:( ) Fax :( ) Minimum 3 t !
Plan review (25% of permit fee)
CCB Lie.: Plumbing Lic. no.:
State surcharge (12% of permit fee) {
Authorized signature: _ TOTAL PERMIT FEE 92, . s 0
/ This p er m it application expires If a permit is not obtained within ISO days
Print name: /j , - Q1 �`� Date: � (/ 1 ap p after it has been accepted as complete.
w �' 'Fee methodology set by Tri-County Building Industry Service Board.
I:'• Buildmg 'Pennits\PL.MU- PermitApp.doc 10 440-4616T(10.'02,COM/WEB) fk?. )- VA (j t • -- - `11' /
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