Permit CITY OF TIGARD PLUMBING PERMIT
IN C • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00221
Date Issued: 07/02/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S109AB12300
Jurisdiction: Tigard
Site address: 14248 SW ALPINE CREST WAY
Project: Shepfer Subdivision: ALPINE VIEW Lot: 4
Project Description: Irrigation backflow device.
Contractor: FOREST LANDSCAPE INC Owner: SHEPFER, ERIN
3975 NW SUSBAUER RD 14248 SW ALPINE CREST WAY
CORNELIUS, OR 97113 TIGARD, OR 97224
PHONE: 503 -648 -8308 PHONE:
FAX: 503 -648 -8095
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/02/2013 $31.27
Specifics: 1 12% State Surcharge - 07/02/2013 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 07/02/2013 $41.23
Type of Use SF 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: Permittee Signature: �p�p �+�j- 7ofr
_44:72)/z2t..._____ 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 Applicati t ,
Fixtures - I ' g
Building It)R 01:l.1(=lr:t cP: O,\i.a .
. City of Tigard JUL 01 2 013 Received
e . ,B !) ,° Permit No. uyaoi3 B o��/
13125 SW Hall Blvd., Tigard, OR 97223 /�
Phone: 503.718.2439 Fax: 503.59 ry Plan Review
OFTIGARD Datellly: Other PemtitNo.:
T I G A R 0 Inspection Line: 503.639.4175 ® Dale Ready/By: I . CS �/ ®See Page 2 for
Internet: www.rigard or.gov BUILDING DIVISION Notified /Method: Supplemental lnformatioa
TYPE OF WORK FEE* SCHEDULE
El New construction ❑ Demolition Forspeclel information use checklist.
Desc�tiop I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other. New I - 2- family dwellings (includes 100 It. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
tjt1- and 2 - family dwelling ID Commerciallindustrial SFR (2) bath 437.78
El Accessory building ID Multi SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: t Fire sprinkler ( sq. ft -) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Li 2 �� �� } A5 l l � � Catch basin or area drain 18.76
City /StatelZIP: �1 ^ [ D 4 l � I ` Drywell, leach line, or trench drain 18.76
l �K- � ��� Footing drain (no. linear ft: ) Page 2
Suite/bldg. /apt. no.: Project name:
3.hf.p.ct-y Manufactured home utilities 50.03
Cross streetldireedons 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 IL: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK - Backwater valv 1 12.51 l 7 •51
Clothes
wa washer 25.02
r rjl r � rt n J► r 1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
1 � r Floor drain/floor sink/hub 25.02
Address: l__: Z k■ ' �'{ �'� C � WOE
City /State /ZIP: j ' /•� 1 � � Garbage disposal 25.02
op l �p2 9 -7 719 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap
25.02
Business name: Y•, j - ` . / • • Medical gas (value: S ) Page 2
Pri mer Contact name: ��(�e 7t�L K i Roofd 12.51
�� jj ` , \ 1.__(-1. ) Roof drain (commercial) 12.51
Address: �l� l� W C 7. fr
��` `� f � q Sink/basin/lavatory 25.02
City/State/ZIP:
C �r1 1f.1 1 I �� oz J f 13 Solar units (potable water) 62.54
Phone- 711 0 go 0 i �J! p ax: •s .11 A ; Tub /shower :shower pan 12.51 l iitspjf
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: .---- '��-`
� �` � C �' q �C Water piping/WV 56.29
Address: 9 - 15 \,( 0 � nis. Other. 25.02
City /State/ZIP: C I� � (l 3J c512 i ) Subtotal
Phone: ( 1 ' L _ `y! Fax ' t *a r Minimum permit fee: 572.50
�E$-T tL 1� r Plan review (25% of permit fee)
_ I� a F Plumbing Lie. no.:
State surcharge (12 %ofpermit fee)
Authorized signature: �� • m >t A TOTAL PERMIT FEE 1
Print n • n ... � - Date: Mk permit application expires if a permit is not obtained w .v days
!_J►v { ` after it has been accepted as complete.
'Fee methodology set by Tri•County Building Industry Service Board.
t: IBuildinglPamitaL\7U -Pere itAppAae 10/0:•19 440.4616TI 10102/COM/WFB) •
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