Permit CITY OF TIGARD PLUMBING PERMIT .
v
11 COMMUNITY DEVELOPMENT Permits: PLM2012 -00329
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/14/2012
Parcel: 2S110BC10600
Jurisdiction: Tigard
Site address: 12064 SW CAFFALL LN
Project: Bull Mountain View Estates, Lot 4 Subdivision: BULL MOUNTAIN VIEW ESTATES Lot: 4
Project Description: Installation of residential backflow device for irrigation.
Contractor: ASHLAND BROTHERS LANDSCAPES Owner: LENNAR NORTHWEST INC ■ ,
2153 MOLALLA HIGHWAY 2103 NE 129TH ST SUITE 100 •
WOODBURN, OR 97071 VANCOUVER, WA 98686
PHONE: 503 - 981 -6131 PHONE:
FAX: 503-981-1058
FEES
.Quantity Description Date Amount
• 1 ea Backflow P.reventer 11/14/2012 $31.27
Specifics: 1 12% State Surcharge - 11/14/2012 $8.70 •
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 11/14/2012 $41.23 •
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
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Total $81.20
Required Items and Reports (Conditions)
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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 qu OUNC by calling 503.232.1987 or 1.800.332.2344.
tssued y: , Permittee Signatu ,
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.
Nov 141207:44p Ashland Brothers 503- 981 -1058 p.1
Plumbing Permit AvnlientioAECEI VE f FOR OFFICE USE ONLY
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i - City of Tigard tc/By: II / V 1A Permit No.: ai jeva -00 324
q 13125 SW Hall Blvd., Tigard, OR 97223
NOV 1 4 2012 ,
T 1 G_4 ft IG l �(J
Phone: 503.639.4171 Fax: 503598.1 Other Permit No.:
Inspection Line: 503.639.4175 Ur .... Plan Review
A �� Date/By:
Date Ready/By mac Sec Pa 2 far
Internet: www.tigatd - orgov RU IL
IS No� tbad: I g ge Sutm�entaltot ormt�tion
I TYPE OF WORK (�� FEE* SCHEDULE
For f special information axe cheeldisf. I . (� New construction ❑Demolition Description 1 Qty. ( Ea. 1
❑ Addition/alteration/replacement ❑ Other: New 1- 2.fainily dwellings (includes 100 ft. for each utility c.nn 'on)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
n l- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building { ❑ Multi - family SFR (3) bath 399.00 j
Each additional bath/kitchen 45.00
❑ Master builder I ❑ Other.
Fire sprinkler ( sq. ft.) I ( Page 2 `!I
JOB SITE 'INFORMATION AND LOCATION Site utilities
Job site address: 1 Z0 6 (4 5 Cek r4&t+ i Catch basin or area drain 16.60
0ty/State/ZIP: Tb fv .per ril zZy Drywe11. leach line. or trench drain 16.60
Suite/bldg. /apt. no.: I Project name B T on . E.s�C ke Footing drain (no. linear ft.: _3 PPage 2
s
Cross street/directions to job site: 5w � r a Manufactured home utilities 1 10.00
Manhole s 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
t
• Storm sewer (no. linear ft.: __) Page 2
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Subdivision: I Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve • 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2
i.-1 CA Sc•1 pe. 1 i Y 1 1 to - /Gf\ Backwater valve 16.60
0 Clothes washer 16.60
Di hwlsher 16.60:
A PROPERTY OWNER I Drinking fountain
EjectEjectors/sump 16.60
16.60
❑ TENANT I
Name: j . y Z ■4--S el C Expansion tank 16.60
Address: ' f( Acrv.4'<tt'�o 'Q . V t 3 oo Fixture/sewer cap 16.60
City /State/ZIP: Cofo v .,, I ;„, ( q 2 Floor drain/floor sink/hub 16.60 .
Phone: 051 ) 3(0 -5$ 0 I Fax: ref, r s rr- Garbage disposal 16.60
. ,® APPLICANT 1 8-CONTACT PERSON Here bib 16.60
,/�� `1 , i- if
maker 16.60
Business name
T' J% a 1 T�X.f 1S Interceptor /grease trap 16.60
Contact name: - -0o 11 541 im we , co Medical gas (value: S
Page 2
Address: 2.4 S3 im 0 Ira to s t2 Primer 16.60
City/State/ZIP: I . ioc b fry ' rtx: '0 'i drain (commercial) 16.60
Phone: 0-43 � Li _� 3 : 5713) I - oS 3 Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet .16.61)
Business name: ASIA 1p, j ri L I5 Water heater 16.60
Address: .Lt S veto 1 p 1 ia. ted Other:
City /State/ZIP: to c( bye?" Ca � J'1 , Subtotal =. , 1
Phone: (� ) F ax: 3 ) Minimum permit fee: S72_50 N Ot •
J 58�- 4131 t -for
CCB Lic.: - 7 f '7 Lf Plumbing Lic. no.: ._ Plan review (25% of permit fee) . Q 7D
Authorized signature / State surcharge (8% of permit fee) e
Y r �' , P TOTAL PERMIT FEE o
I Print name --- A T tFi 1 9 1 Date: This permit application expires iP a permit is not obtained within 0
180 days after it has been accepted as complete.
*Feu methodology set by Td- County Building Industry Service Board.
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