Permit CITY OF TIGARD PLUMBING PERMIT
I I I 2 COMMUNITY DEVELOPMENT Permits: PLM2013-00167
• Date Issued: 06/03/2013
TIGARD 13125 SW HaII'Blvd., Tigard OR 97223 503.718.2439 parcel: 2S 03/201 6200
Jurisdiction: Tigard
Site address: 14230 SW VISTA VIEW CT
Project: Swanson Subdivision: SHADOW HILLS NO.2 Lot: 45
Project Description: Replace backfiow assembly.
Contractor: OREGON BACKFLOW TESTING LLC Owner: SWANSON, LOWELL N TRUSTEE
12292 SW GALA CT 14230 SW VISTA VIEW CT
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 -491 -9402 PHONE: 503 -684 3445
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 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. low!
Issued By: Permittee Signature: \
��' lll.. Call 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 RECEVEF FOR OFFICE USE ONLY
City of Tigard R eceived
/5 Ii• ertnit Nye V 13125 SW Hall Blvd., Tigard, OR 97223 JUN - 3 2013 Date/By: 5 „ r °200 i-3 Vd /k 7
: C Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit No •
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/B• Ju riyj 61 ® See Page 2 for
Internet: www tigard -or gov
5 I .1 I E.r,fl t'�l!� Notified/Method: Supplemental Information
.� ENVISION
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 (I) bath 312.70
® 1- 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: 14230 SW Vista View CT 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: Swanson Manufactured home utilities 50.03
Cross street/directions to job site: McFarlund & Vista View 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: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer L 31.27 3 )• Z7
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replacement of backflow assembly Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Lowell Swanson Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 14230 SW Vista View CT
Garbage disposal 25.02
City/ State/ZIP: Tigard OR 97224 Hose bib 25.02
Phone: (503)684 -3445 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
Water closet 25.02
CONTRACTOR
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: Portland, OR 97224 Subtotal
Phone: (503) 491 -9402 Fax: ( ) Minimum permit fee: $72.50 72.50
CCB Lic.: LCB # 9144 PI t bin: j ic. no.: Plan review (25% of permit fee)
� State surcharge (12% of permit fee) 8.70
Authorized signature: DS , „ O'' TOTAL PERMIT FEE 81.20
Print name: Dave Crosswhite Date: 5 - - 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.
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