Permit CITY OF TIGARD PLUMBING PERMIT
3 1 11 11 COMMUNITY DEVELOPMENT Permit 9: PLM2013 -00166
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/03/2013
TIGARD Parcel: 2S110BA07200
Jurisdiction: Tigard
Site address: 12009 SW WILDWOOD ST
Project: Manoch Subdivision: SHADOW HILLS NO.2 Lot: 57
Project Description: Replace backflow preventer and shut -off valve.
Contractor: OREGON BACKFLOW TESTING LLC Owner: MANOCHA, RITU
12292 SW GALA CT 12009 SW WILDWOOD ST ,
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503 - 214 -2032
HONE: 503 - 491 -9402
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/03/2013 $31.27
Specifics: 1 12% State Surcharge - 06/03/2013 $8.70
Plumbing
Type of Use: SF
41 ea Minimum Fee Adjustment - 06/03/2013 $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 Muniapal 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. ij14 jj1Jtj') .AM
Issued By: Permittee Signature: I ,,S;r 7 4 .7(.74..e.____
/
Cali 503.639.4176 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.
Plumbing Permit Application
Building Fixtures R EC F \IED
R eceived 473 i..3 *v___ /� 020 ,3_ ,�l/1, 6 6
City of Tigard Pertnrt No • C/C/
a 13125 SW Hall Blvd., Tigard, OR 97223 I I J Plan Review
. C Phone: 503.718.2439 Fax 503.598.1%T N - 3 2 3 Plan Review Other Permit No
Inspection Line: 503 639.4175 Date/By: "1• I G n R D Internet: www.ti ard -0r. ov _ CI OF TIGARD Date Ready/By r`` '� See 2
g g r� Notified/Method: / t Supplemental Page Information
TYPE OF WO WILDING D1VIISIO 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
® I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
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: •12009 SW Wildwood St Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manoch Manufactured home utilities 50.03
Cross street/directions to job site: McFarlund and Wildwood ST 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
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replace backflow preventer and shut -off valve Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Ritu Manoch
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12009 SW Wildowood Street
Garbage disposal 25.02
City /State/ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)214 -2032 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Oregon Backflow Testing, LLC
Water piping/DWV 56.29
Address: 12292 SW Gala CT Other 25.02
City /State/ZIP: Tigard, OR 97224 Subtotal
Phone: (503) 491 -9402 Fax: ( ) Minimum permit fee: $72.50 72.50
CCB Lic.: LCB # 9144 O�`/ Plumbing Lic. o.: Plan review (25% of permit fee)
J � State surcharge (12% of permit fee) 8.70
//
Authorized signature: / (0 TOTAL PERMIT FEE 81.20
Print name: Dave Crosswhite / Date: 6-1 -13 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
•Fee methodology set by Tn- County Building Industry Service Board.
t \ BuildingtParnits WLMU- PernitAppdoe 10 /01/09 440- 4616T(10/02/COM/WEB)