Permit - u
CITY OF TIGARD PLUMBING PERMIT
$ • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00199
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 06/24/2013
Parcel: 2S104BB10700
Jurisdiction: Tigard
Site address: 14032 SW WALNUT CREEK WAY
Project: Walnut Creek, Lot 24 Subdivision: WALNUT CREEK Lot: 24
Project Description: Install residential backflow preventer for irrigation
Contractor: CASSERLY LANDSCAPE INC Owner: LEGEND HOMES
2951 SW MOSSY BRAE 12755 SW 69TH AVE., STE 100
WEST LINN, OR 97068 PORTLAND, OR 97223
PHONE 503-638-4646 PHONE' 503 - 620 -8080
FAX 503 - 638 -8244
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/24/2013 $31.27
Specifics: 1 12% State Surcharge - 06/24/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 06/24/2013 $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
Utili notification • ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or erect questions to O C by calling 503.232.1987 or 1.800.332.2344.
Is ued By: / Permittee Signature: /'
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.
Plumbing Permit Application ce
RECE IVE Site Utilities E•11 �/ D / n FOR OFFICE USE ONLY // �2 �✓� o �y
1i i v +-� DaiBe �� �
Date/By A/ �J- w/ r
City of Tigard Re eiv d
e / Permit No
q 13125 SW 1 -fall Blvd , Tigard, OR 97223 iN 2 4 2013 Plan Review
Phone 503 718 2439 Fax 503 598 f9�iC Other Permit No
y
TIGARD Inspection Line 503 639 4175 CTI Date Ready /By tuns 0 See Page 2 for
Internet www tigard gov Notified /Method Supplemental Information
TYPE of \ ,DINGDIVISION
FEE* SCHEDULE
For special information use checklist.
❑ New construction ❑Demolition
Description I Qty I Ea I Total
❑ Addition /alteration /replacement ❑ Other' New I- 2- family dwellings (includes 100 0 for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312 70
-
11 and 2- Family dwelling El Commelcial /industrial SFR (2) bath 437 78
SFR (3) bath 500 32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25 02
❑ Master builder ❑ Other. Fire sprinkler ( sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
W `N� Catch basin or area drain 18.76
Job site address'
,403� a wA
Drywell, leach line, or trench drain 18 76
City /State /Z_IP °r A¢..t: 4 O�
Footing drain (no linear ft . _) Page 2
Suite /bldg /apt. no. Project name: tijamLpJVT Gw.GS1 _ Manufactured home utilities 50 03
Cross street/directions to job site. 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. V.So.tn C . — I Lot no.: Z'{ Fixture or item:
Tax map /parcel no ZSICA - $$ I�-p0 Backflow preventer I 31 27 31 27
Backwater valve 12 51
DESCRIPTION OF WORK
, Clothes washer 25 02
raCC..-Y-m 1ivC{ L -&✓\.d S Cafe , Y Y
{yJ .-
t vG 0 - Dishwasher 25 02
J t:.,C.Ac, -Clot.) Drinking fountain 25.02
Ejectors /sump 25.02
i PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Fixture /sewer cap 25 02
Name:
(rGl acND (- 1,e)oss
Floor drain /floor sink/hub 25 02
Address: \Z S g ,„/ . 7-2- 4. (00 °
Garba disposal 25.02
City /State /ZIP. -- : > 0 1- \ —o.rsD t O 2 Hose bib 25 02
Phone: ( 503) ca-o - $d$O Fax: ( ) 5 -$ °tOO Ice maker 12 51
,APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 2502
Business name: I.�fwER1D Medical gas (value: $ ) Page 2
�LOMES Primer 12.51
Contact name 4 V k--A.seqS
Roof drain (commercial) 12 51
Address: 1 7.- - 7SS S '* 2 ., a A,,, .%tCD Sink/basin/lavatory 2502
City /Stale /ZIP: TS•ga-L, p. Wt ` 0g. _ 1 * 22.7S, Solar units (potable water) 62 54
Phone: (5-Os) 620 -QtO$0 Fax: : ( 503) 5913 - SI 0o Tub /shower /shower pan 12 51
Urinal 25 02
E -mail: g(a)CA% p(. te. Lprt. Water closet 2502
CONTRACTOR
Water heater 37 52
Business name: CAA 65 ER.I.`f LAN D Saki: E. Water piptng/DWV 56.29
Address. 2. 5w M056 '1 Cbt2AE Other. 2502
City /State /ZII': w ESQ( 1 1 N N i 0 b
C I 1 °S Subtotal 31. Z
Phone: ( 6031 ( - 4(4� Fax: ( ) Minimum permit fee $72 50
CCB Lie.: t.7!] 7 9cf &V 3 Plumbing Lic. no : Plan review (25% of permit fee)
t State surcharge (12% of permit fee)
Authorized signature: i( T ' v v TOTAL PERMIT PEE
PI'lltl name. �"l �t V "`` ����"'"�������—
Date: 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
5,
\ttumtitiimg\t'crmnmms\i'LNIU-t'crimmitApp doe 10 /01/09 440- 4616T(10 /02 /CONIAVEE)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14032 SW WALNUT CREEK WAY, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
06/28/2013 00:00
PLM2013-00199
PASS - No C of O
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14032 SW WALNUT CREEK WAY, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
06/28/2013 00:00
PLM2013-00199
PASS - No C of O
Violation Summary:
Inspector Contractor