Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00096
T f G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/25/2013
Parcel: 2S104CD03700
Jurisdiction: Tigard
Site address: 13641 SW BENCHVIEW TER
Project: Baker Subdivision: HILLSHIRE ESTATES Lot: 37
Project Description: (1) backflow device rerplacement
Contractor: LJH LANDSCAPE & IRRIGATION Owner: BAKER, TIM & LINDA
14210 SW KIMBERLY DR 13641 SW BENCHVIEW TER
BEAVERTON, OR 97008 TIGARD, OR 97223
PHONE: 971-285-1691 PHONE: 503 - 352 -5297
FAX:
FEES
Quantity Description Date Amount
•
1 ea Backflow Preventer 03/25/2013 $31.27
Specifics: 1 12% State Surcharge - 03/25/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 03/25/2013 $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: ` I l / Permittee Signature: tt j /i 2P I ^ D �1
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 1T c�l (p T7 / I
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.
rr
FROM : CMH DESIGNS FAX NO. :5033525432 Mar. 24 2013 11:17AM P1
Plumbing ° CEWED
Site Utilities 1 ( ,N 4 )141( I I ";I.
cit of Tigard i‘fl A li 2 5 2013 Rccoivoil
Datanty; 3 las" 1 3 Sr Peemil NI°: e141 go13-o00 94
• 13125 SW Hall 131vd., Tigard. OR Pl
972.43,,, ,‘,.,„„„ ,, ,r,, -
an Review
•
• Phone: 503.718.2439 Fax: 503.59.M41 vr 111/11KU DaleIlly: Other Parnit No.!
I i i.. ,-.■ I( r) inspection t Arse: 503.639.4175 BUILDING DIVISION Date Rcady/By: Anis; &l See Paw 2 fer
rn . ..
Inteet: www.tigard Nutilicd/Mahod: 11 co Supplemental Information
• .. .
1. ..:•'• ,"::.!...: .. • .. : '•.. .• '.' .. ' TYPE OF WORK - • . .
" . . . . FEE" SCHEDIII.E ' , ' • ''• • • ' '
• .
0 New construction EI Demolition Fur xpeaal i rotation FOE cheelaist
, T)oscription qty. I Ra. I TLtiit
CE Addilion/alteration/replument 0 Other: Ncw 1- 2-Timilly dwellimg a (includes 100 R. Ihr each utility connection)
CATEGORY...OF CONSTRTICTION .. - • SFR (1) bath 312.70.
El I- and 2-family dwelling 0 Commercial/industrial - SFR (2) bath 437311
500_32
0 Accessory building CI Multi family - SFR (3) bath -
Finch additional bath/kitchen 25.02
ID Master builder 12 Otticr: „ Fire sprinkler ( sq. IL) Nip 2
4 INFORMATION' AND tOcAnori . .... .. -. . Site Milkiest ...„ . ..__
. _.-
Job site address: 13641 SW BENCITYTEW 'I'ERIL Catch basin or area draM 1876
Drywell, leach line, or trendi drain 18.76
City/State/Z1P: TIGARD, OR 97223
' Footing dmin (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name: DA CTCFLOW REPLACE Manufactured home utilities 50.03
,.., . ._ ,... .......
Cross street/direethms to job site: WEST OR SW GREF,NFIELD DR., (41/4 MHZ Manholes 1876
•
, Rain drain connector I 8.7ft
.... _
- ..... -•,- .-.-
Sanitary sewer (no. linear ft.: ) Page 2
StOrrn sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: _.) Page 2
Subdivision: lAd. no leixture or item: -
• ... .. ........
Tax map/parcel 710.: - _ Back flow preventer 1 31.27 31.27
, - . .Rackwater valve 12.51
', '.'r'.••..:': ;.:.'..'. . -: ' • .• ' .-.'' - 'ITESCRIPIION OF WORK ." '
' • Clothes washer 25,02
KEPTACE DEE1X:T1VE BACKFT,OW DEVICE.
Dishwasher 25.02 -
Drinking liumtain 25,02
Ejectors/sump _ . 25.02
ii E,I.AkTitikittil (Min: . ..... .: L . . .0 TiNANt..,.... - .. - , Expim s hin tank 12.51
Name LINDA AKER Fixture/sewer eap 25,02
:
Fluor drain/floor sink/hub 25.02
Address: 13641 sw BENCIIVIEW TERR.
Garbage disposal 25.02
City/Slulc./ZIP: TIGARD, OR 97223
Hose bib 25.02
Phone: (50.3)352.5297 Fait: ( ) ice MairCT 12.51
'''''''.".. I: .',; ' .. '''. • AiTticANT . .. • . • . D coNinet.. pritsco . Intcrcoptodgrease (nip 25.02
-, Medical gas (value: $ ) Page 2
Business name: 1-111 LANDSCAPE & IRRIGATION
Primer 12.51
Contact name; TARRY IIOEKMAN
Roof drain (commercial) 12.51
Address: 14210 SW KIMBF.RTN DR.
Sink/basin/lavatory 25.02
City/State/ZIP: BEAVERTON, OR 97008 Solar units (potable water) 62.54
Phone: (971) 285.1691 ... Fax •
.. ( ) - Tub/shower/shower pan 12.51
• - -
"" --
Urinal
E-mail: larry(iidjhlandscaspeandirrigation.com 25.02
Water closet 25.02
.-1 .:.' , ,,..: ,.... . .. ' • ..... • - ... :,CONTRACTOW . . . ‘ , , '': . .. , '.
• , Water heater 37.52
Business name: Lin LANDSCAPE & IRRICIAl'ION Water piping/DWV 5629
....., ..__.... .. -_..._
Address: 14210 SW KIMBERLY DR. Other 25.02
City/State/ZIP: BEAVERTON, OR 97008 StIblutal 31.27
...
Phone: (971) 285.1691 F&x: ( ) - _ Minimum permit fee: $72.50 72 50
CCB Lie.: 8792 1 -4tEr 3 Plumbing Lic. no.: WI 8792 Plan review (25% (permit IC)
•
Slate surcharm (12% of permit fbe) 8.70
Authorized signal dr ,, ..\ .r.,..i.. a .... ______.
TOTAL PERMIT FEB 81.20
Print name: LAIill MI.Orp , , , Dalt: 03/21/2013
- II] ThiTt;e1;;iit application expires If s permit in not obtained within 180 days
aftcr it hag been accepted as compictr,
6 1ko methodology set by iti-County Building Tiakrury Service feted.
tAltaild ineWermil 811'1 MU-PemitApp.dcm 10/01KA 400-4616T(I0IO2ICPWW1M) ' 1