Permit 1111 11-
CITY OF TIGARD PLUMBING PERMIT
t; COMMUNITY DEVELOPMENT Permit #: PLM2013 -00222
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2013
Parcel: 2S 103CA00603
Jurisdiction: Tigard
Site address: 13400 SW 121ST AVE
Project: Petitt Subdivision: WOODCREST Lot: 11
Project Description: Irrigation backflow device.
Contractor: FOREST LANDSCAPE INC Owner: PETITT, THOMAS
3975 NW SUSBAUER RD 13400 SW 121ST AVE
CORNELIUS, OR 97113 TIGARD, OR 97223
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
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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: 0/V /4W/ L/ e `/ 7 7 O /V
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 ADUlica"{idnI\ j1'
Building Fixtures JUL 0 1 2013
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City of Tigard Received
>�Ie�y: 1/ Petmit No ,�U yaoi3 .V62 2,2_, 13125 SW Hall Blvd., Tigard, 0 • , OFTIGARD
Phone: 503.718.2439 Pas t Plan Re""""
• DIG DIVISION Date/Hy: Other Permit No.:
T I G A RD Inspection Line: 503.639.4175 ` n paw R l
Intnet: www.tigard or.gov y H Sec Page 2 me
Notified/Method: I i Supplemental Informat
er on
TYPE OF WORK FEE* SCHEDULE
For special information use checklist
❑ New construction • ❑ Demolition
❑ Addition/alteration/replacement ❑ Other: ii
Descrpton I Qty. I Ea. J Total
New I- 2- family dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
\ EU - and 2- family dwel ling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
❑Master builder Each additional bath/kitchen j 75
Other: Fire sprinkler ( sq. ft) I l Page 2
. J08 SITE INFORMATION AND LOCATION • Site utilities:
Job site address: I : F5 t 1 i zi 4\4, Catch basin or area drain 18.76
City /State/ZIP: -T q��- (.� 9 -722 ,-) Drywelt drain line, l oe trench drain 18.76
e 2
!J ,I l I Footing drain (no. linear R.: ) Page
Suite/bldg. /apt. no.: I Project name:
+ 1 Manufactured home utilities 50_03
Cross streetidirections 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 tt.: ) Page 2
Subdivision: Lot no.: Fixture or item: •
Tax mapiparcel no.: Backfow preventer I 31.27 i 1 ? `�
DESCRIPTION OF WORK Backwater valve ` 12.51
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\ ( fl C . 4 - 1 C \li Clothes washer 25.02
Dishwasher 25.02
]pinking fountain 2502
Ejectors/sump 25.02
PROPERTY OWNER I . ❑ TEN Expansion tank 12.51
Name: �OYY ; i Fixturcfscwercap 25.02 •
Address: 2 j�{ /11� 8iii.,, ti I Floor drain/floorsink/hub 25.02
I l �J 9' 7 Garbage disposal 25.02
CCity/State/ZIP: �T-j rq/1 r �`� I Hose bib 25.02
Phone: ( ) I Fax: ( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease
_ p grease trap 25.02
Business name: �VY l � Medical gas (value: S ) Page 2
` � �Crk - i Pr imer
Contact name: 'kyyl 12.51
Address: 1 Roof drain (commercial) 12.51
)9 "75 KJ ` t
1 / 4 .! ` Sink/basin/lavatory avatory 25
City /State/ZIP; _
� ti •ILL C) 7 1) Solar units (potable waver) 62.54
Phone :, __ • e :bib. • Fax:,: ...' l 0 - :4 Tubishower/shower pan 12.51
E -mail: - - Urinal 25.02
CONTRACTOR Water closet 25.02
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Business name: .') I--j r) V hi+/
� -'V C t -)c Water heater 56 52
l l� lC : WaterpipingJDWV
Address: ! y �� _ )� . ' �Y A t � 0 9._ 5
Other: 25.02 2
City /State/ZI: � 1
�Z � 9?) /3 Subtotal 4.
Phone: 0 Q °--4 la Fax• .•.e ) 16 Minimum permit fee: $72.50
B 6to•: ! Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: / State surcharge (12% of permit fee) `�
1
l - �. ` _ 4 L � I. _ TOTAL PERMIT FEE
Print name: ' . ' � . Daze - /
This permit appncarton expires if a permit is not obtained wi i i days
_ .� - � I ' after it has been accepted as comptete. t.../'
'Fee methodology set by Tri County Building Industry Service Board.
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