Permit + ,� CITY OF TIGARD PLUMBING PERMIT
:''� : COMMUNITY DEVELOPMENT Permit#: PLM2013-00292
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/21/2013
Parcel: 2S 104BC06600
Jurisdiction: Tigard
Site address: 14255 SW WALNUT LN
Project: McDonald Subdivision: BAILEY WOODS Lot: 2
Project Description: Irrigation backflow device.
Contractor: SIGNATURE LANDSCAPE CARE INC Owner: POUNDER, GAYLAND R
PO BOX 304 MCDONALD, MICHELLE C
TUALATIN, OR 97062 14255 SW WALNUT LN
TIGARD, OR 97223
PHONE: 503-673-0142 PHONE:
FAX: 503-673-0189
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/21/2013 $31.27
Specifics: 1 12%State Surcharge- 08/21/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/21/2013 $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. /
Issued By: / Permittee Signature: 9p/0�/e��O
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
Building Fixtures FOR OFFICE USE ONLY
��
City of Tigard 0�3 Received Permit No.:
v 13125 SW Hall Blvd.,Tigard, l Date/By: r.g, /3 Pt/y,2o/3 da,2.92.,
+ ®n Plan Revie
II Phone: 503.718.2439 Fax: 50+, '`:.196�G 1' Vr``� Other Permit No.:
v Date/By:
Inspection Line: 503.639.4175 Q` \ �O Date Read/B Jura
TI G A R D Internet: www.tigard-or.gov ��� Ready/By: ,/�//® See Page 2 for
V: cP Notified/Method: '! . Supplemental Information
TYPE OF WORK �\() FEE* SCHEDULE
❑New construction ❑D-'.. Ition For special information use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New I-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
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:
Job site address: 14255 SW Walnut Ln Catch basin or area drain 18.76
City/State/ZIP:97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site:Windsong Ct 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 I 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Irrigation Installation Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Michelle McDonald Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 14255 SW Walnut Ln
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Signature Landscape Care,Ltd. Medical gas(value:$ ) Page 2
Contact name: Brian Smith Primer 12.51
Roof drain(commercial) 12.51
Address:21375 NW Cherry Ln
Sink/basin/lavatory 25.02
City/State/ZIP: Hillsboro,OR 97124 Solar units(potable water) 62.54
Phone:(503)673-0142 Fax: :(503)673-0189 Tub/shower/shower pan 12.51
E-mail:Brian @landscapecare.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Signature Landscape Care,Ltd. Water piping/DWV 56.29
Address:21375 NW Cherry Ln Other: 25.02
City/State/ZIP: Hillsboro,OR 97124 Subtotal 31.27
hone:(503)673-0142 (503)673-0189 Minimum permit fee: $72.50 72.50•CCB Lic.:6195 �/ /� Plumbing Lie.no.; Plan review (25%of permit fee) 18.13
-YY State surcharge(12%of permit fee) 8.70
Authorized signature: - �`�`d'/ TOTAL PERMIT FEE I 99.33
Print name: Brian Smith Date:08/15/2013 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.
P\Bui!ding\Permits\PLMU-PermitApp.doc 10/01/09 440-46I6T(10/02/COM/WEB)