Permit CITY OF TIGARD PLUMBING PERMIT
' � COMMUNITY DEVELOPMENT Permit #: PLM2013 00109
'
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01/2013
Parcel: 2S112BC08600
Jurisdiction: Tigard
Site address: 14796 SW 81ST AVE
Project: White Subdivision: RAZE MEADOWS Lot: 9
Project Description: Installation of residential backflow preventer for irrigation
Contractor: LJH LANDSCAPE & IRRIGATION Owner: WHITE, RODNEY P AND GAIL T
14210 SW KIMBERLY DR 14796 SW 81ST AVE
BEAVERTON, OR 97008 TIGARD, OR 97224
PHONE: 971 - 285 -1691 PHONE: 503 684 -9578
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/01/2013 $31.27
Specifics: 1 12% State Surcharge - 04/01/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 04/01/2013 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This ermit is issued subject to the regulations p � c o t e egu ations 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 - 001.1090. You may obtain a copy of the rules
or direc estions to : NC b .fling 503.232.1987 or 1.800.332.2344.
lssu d By: ` / #0, / - Permittee Signature: di vap t lt , 0
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.
Plumbin Perm A licatio EIVED
Site Utilities I OR OFFICE I SI; ONLI
City of Tigard Ti an APR Received 0111/47Z/5„, �U l0
g 1 2013
Date/By: y
Er
■ 13125 SW Ha Blvd., Tigard, OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.1 TIG A n 1J Date/By: No.: y_ Other Permit No.:
Inspection Line: 503.639.4175
T ► G A R D B UILDIN � Date Ready/By: !oils: See Page 2 for
Internet: www.tigard- or.gov G DN I SION Notified/Method: I ® Supplemental 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
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14796 SW 81" Ave. Catch basin or area drain 18.76
City/State/ZIP: 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Landscape Irrigation Manufactured home utilities 50.03
Cross street/directions to job site: SW Bonita Rd., @500' south Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _J 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 I 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Install new backflow device for new landscape sprinkler system being installed, Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Rodney & Gail White Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 14796 SW 81 Ave.
Garbage disposal 25.02
City /State/ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)684 -9578 Fax: ( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: LJH Landscape & Irrigation
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Larry Hoekman
Roof drain (commercial) 12.51
Address: 14210 SW Kimberly 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
E- mail: larry@Ijhlandscapeandirrigation.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: LJH Landscape & Irrigation Water piping/DWV 56.29
Address: 14210 SW Kimberly Dr. Other: 25.02
City/State/ZIP: Beaverton, OR 97008 Subtotal 31.27
Phone: (971) 285 -1691 Fax: ( ) Minimum permit fee: $72.50 72.50
Plan review (25% of permit fee)
CCB Lic.: LCB ti8792 3 /;//( Plumbing Lic. no.: State surcharge (12% of permit fee) 8.70
Authorized signature: \ , Q �^ TOTAL PERMIT FEE 81.20
Print name: Larry J. H n 111111/4 ��--�� �� Date: 04/01/2013 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.
I:\ Building \Permits\PLMU- PamitApp.doc 10/01/09 440- 4616T(10/02/COM/WEB)