Permit rti
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00325
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/06/2012
Parcel: 1 S125DC07600
Jurisdiction: Tigard
Site address: 7023 SW ASH CREEK CT
Project: Ash Creek Estates, Lot 9 Subdivision: ASH CREEK ESTATES Lot: 9
Project Description: (1) backflow preventer for new SF
Contractor: BURNESS LANDSCAPE Owner: ASH CREEK PROPERTIES LLC
8630 SW SCHOLLS FERRY RD 12655 SW NORTH DAKOTA ST
BEAVERTON, OR 97008 TIGARD, OR 97223
PHONE: 503 - 572 -0009 PHONE:
FAX:
FEES
Quantity . Description Date Amount
1 ea Backflow Preventer 11/06/2012 $31.27
Specifics: 1 12% State Surcharge - 11/06/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 11/06/2012 $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 +t started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow t rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. Y. ay 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:
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. rt'
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application RECEIVE i
Building Fixtures FOR OFFICE USE ONLY
City of Tigard NOV 0 6 2012 Received 1 j' 0 / �-- Permit No.: pL.A..f 4 a- qv 3 3�
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Re : l
C ITY OF T view
Other Permit No/14 � t T 00 I ^ [/ ,1 0 X /
D an Re
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
T I G A R D Inspection Line: 503.639.4175 p � ��� Date Ready/By: See 2 for
Internet: www.tigard- or.gov 1 pUJLDING Notified/Method: 11 Supplemental Page Information
TYPE OF WORK ( FEE" SCHEDULE
New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
0 1 - and 2- family dwelling CI 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. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
iota 3 S , - W f Po � C 1 � I CA", Catch basin or area drain 18.76
Job site address: C.
Dtywell, leach line, or trench drain 18.76
City/ State/ZIP: O 0 ( �'� 2,2
1 a e Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: Project name: ANIIIff_ Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
' Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
o
Subdivision: I Lot no.: l Fixture or item:
Tax map /parcel no.: Backflow preventer , 31.27
DESCRIPTION OF WORK Backwater valve 12.51
\\ Clothes washer 25.02
t� ! L I ( b 4G 1� tb l.) Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
,1 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: t , f j o �
Fixture /sewer cap 25.02
W Floor drain /floor sinlc/hub 25.02
Address: _ Garbage disposal 25.02
City/State /ZIP: l 64n) - . Hose bib 25.02
t
Phone: ( ) Fax: ( ) Ice maker 12.51
121 APPLICANT CI CONTACT PERSON Interceptor /grease trap 25.02
Business name: /jL /h IA Medical gas (value: $ ) Page 2
Contact name: /' p p% Primer 12.51
ll Roof drain (commercial) 12.51
G
Address: O t, 3 S W Ct;KO l S r lW , Sink/basin/lavatory 25.02
City/State/ZIP: - R ea V + OIL S 900 Q Solar units (potable water) 62.54
Phone: (q Z ) ) d , c 9 Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: 1,iye L ) jc
Water piping/DWV 56.29
Address: S a- Other: 25.02
City/State/ZIP: Subtotal
+.
Phone: ( ) 3 f lax: ( ) Minimum permit fee: $72.50,
CCB Lic.:pe f7 7 Plumbing Lic. no.: Plan review (25% of permit fee)
� G � A , State surcharge (12% of permit fee)
Authorized signature: �,�/ TOTAL PERMIT FEE ``'',,
Print name: � rJ i.,� 2 v/4 _ Date: //. G /4,7 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.
l:\ Building \Pertnite\PLMU- PcemitApp.doc 10/01/09 440- 4616T(10/02/cOM/WEB)