Permit f PLUMBING PERMIT
CITY OF TIGARD
Il
3 • : COMMUNITY DEVELOPMENT Permit #: PLM2010 00282
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 2S104AD05900
Jurisdiction: TIGARD
Site address: 12918 SW SEVILLA AVE
Subdivision: WALNUT CROSSING Lot: 6
Project: Walnut Crossing
Project Description: Backflow for irrigation.
Owner: FEES
CASA TERRA LLC Quantity Description Date Amount
PO BOX 1082
CLACKAMAS, OR 97015 1 ea Backflow Preventer 08/26/2010 $31.27
PHONE: 1 12% State Surcharge - 08/26/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 08/26/2010 $41.23
Contractor: Plumbing
4 A LANDSCAPE & IRRIGATION INC
63391 OMER DR
BEND, OR 97701
PHONE: 541 - 419 -3003
FAX: 541 - 312 -8793
Type of Use: SF
Class of Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. 4111111P __
Issued By: Permittee Signature: / ` •
/i
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Aug 24 10 12:19p 4A Landscape & Irrigation `} 5413128793 p.3
Plumbing Permit Application . '
Building Fixtures . !.. \ '
: f01 OF;1141 I SF try L4
City of Tigard Received � Permit LV
13125 SW Halt Blvd., Tigard, OR 97223 1\\C'). c rs ChS `N ► , v 11 .. i •
r
Phone: 503.639.4171 Fax 503.598.1960 i 1;jC , \.'" • • )Dh 'e-Review �
l h
Inspection Line: 503639 ® Other Permit No.:
..4175 Cy; � DatelBy
l t,AR 1. et: www.tigard or.gov� ` .
Page
e ! 1?ate ReadY�Y: I runs € El See P 2 for
l ax \\\,\P Notified/Method: - Mar f Supplemental Information
TYPE OF WORK 1 FEE* SCRED[II:E
wcotustruction
/// ❑ Demolition For special lnjarnr:ionr/sechecklist
1 Qty. 1 Ea. Description
❑ Addition/alteration/replacement ❑ Other: New 1- 2 -famil kdwelli f Total
y lags (includes 100 $. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
(br and 2- family dwelling 0 Commerciatfindusttial SFR (2) bath I 437.78
❑ Accessory building ❑ Multi- family SFR) bath , I 50032
❑ Master builder Each additional bath/kitchen 25.02
❑ O ��' Fire sprinkler ( II sq. (1.) Page 2
JOB SITE INFORMATION AND - LOCATION Site utilities: -1
Job site address: I ' S • Ste. I. 1 C3- -� _. `= . (^ tch basin or area drain 18.76
City/State/ZIP: 4 0+♦ ' f nvell, l each tire, or trench drain l
a "i Footing drain (nod linear ft: ) Page 2
Suite/bldg. apt, no.: Project n e: Manufactured hole utilities 50.03
Cross street/directions to job site: 4301.% lettAimp Manholes I 18.76
Rain drain conne;or 18.76
Sanitary sewer (nog linear R: ) Page 2
� , j Storm sewer (no. linear ft.: ) Page 2
,ft A 1
Subdivision: . •• 71 i Water service (n4 linear ft : ) Page 2
_ * � ; , L ot no,: A i Fixture or item: if I 3i
Tax map /pat eel no.: Backflaw preventer 1 3 1.27
DESCRIPTION OF WORK Backwater valve 12.51
♦ b _ I Clothes washer 25.02
washer I 25.02
Drinking fountain 25.02
Ejectors/sump f 25.02 1
[•PROPERTY OWNER ❑ TENANT I Expansion tank i 12.51
Name: ? r��5 Fixtuve/sewercap 25.02
Address:
r � Floor drain /floor sink/hub ik/hub 25.02
City/State/ZIP: dis al I 25.02
Hose bib I I 25.02
Phone: ( ) Fax: ( ) Ice maker
1 12.51
(^APPLICANT ❑ CONTACT PERSON Interceptor/grease nap 1 25.02
ri
' Business name: 6.k � f i / r 1 I Q � Medics[ gas (value: IS ) Page 2
Contact name:�4, .e 'k-., v U Primer ( 1251
Roof drain comnieicial) 12.51
Address: 10 5 1 OrYk.8./r` 'Q Sink/basin/lavatory 25.02
City/State/ZIP: T a ♦ Ilik / Solar units (potable Water) 62.54
Phone: ( 541 ) 1 t Q„ a Q 3 Fax: : (5 %) 312._ 8 -9 3 Tub/showerishowcrlpan 12.51
Urinal 25.02
• s s. A o. - . I. d , • / l .l.tl . ...1 S ► 1
E il:
Water closet 25 - 02
CONY : • CTOR . I
Business name: a,�, Water heater 37.52
�vL a WaterpipingfDWV 56.29
Address: Other. ! 25.02
City /State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee $7250 ��
CCB Lic.: 1 ^�1 Plumbing Lie. no.: Plan review (25% of perms fee)
1 �� State surcharge (12% of permit fee) ,
Authorized signature: I' � ew pi>+ _ �� TOTAL PERMIT FEE ;' Ti .)10
Print name: � � � b Date . This permit applii:ativa expires If a permit is not obtained within :;r : ys
i �a after it has been accepted as complete , a
*Fee methodolo set by Tnsm .Co y Building Industry Sere" Q! r
1; 1 A uildirePetmiu`PLMU- PmniiApp.doe 10/01/09 440 -1616T(10r071CQM1wE$)