Permit CITY OF TIGARD PLUMBING PERMIT
Z COMMUNITY DEVELOPMENT Permit#: PLM2014-00156
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/13/2014
Parcel: 2S103DD00420
Jurisdiction: Tigard
Site address: 10825 SW FAIRHAVEN WAY
Project: SAMPLE Subdivision: FAIRHAVEN COURT Lot: 13
Project Description: Backflow for irrigation.
Contractor: LJH LANDSCAPE&IRRIGATION Owner: SAMPLE, SUE ELLEN&
14210 SW KIMBERLY DR VARNES,ALFRED M JR
BEAVERTON, OR 97008 10825 SW FAIRHAVEN WAY
TIGARD, OR 97223
PHONE: 971-285-1691 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/13/2014 $31.27
Specifics: 1 12%State Surcharge- 05/13/2014 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/13/2014 $41.23
Plumbing
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 95 401-0090. 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:
.111 4
Call 503.639.4175 by 7:00 a.m.for the next available inspeGtio•
This permit card shall be kept in a conspicuous place on the job site until completio - the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application ``11��
Building Fixtures C�j�\ FOR OFFICE USE ONLI
City of Tigard �� Received Permit No.: lL w,,
11111
• 13125 SW Hall Blvd.,Tigard,OR 97223 1 t �01� y: �/��1�� ` �rf�` -d D t
Phone: 503.718.2439 Fax: 503.59 1 i0 ).i7 Plan Review
_ M Other Permit No.:
``_ Q Date/By: _ _ -
i I GARD Inspection Line: 503.639.4175 wN� Date Ready/By: orris: la See Page 2 for
Internet: www.tigard-or.gov V� O� Notified/Method: '7ZC. Supplemental Information
TYPE OF W 81,1/44.3 FEE* SCHEDULE
®New construction i/molition For special information use checklist
Description I Qty. I_ Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-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
. *QB SITE INFORMATION AND LOCATION Site utilities:
Job site address:10885 SW Fairhaven Way Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
-
Footing drain(no.linear ft.: ) Page 2
Strite/bldgJapt.no.: I Project name: SC4nry)Le.- Manufactured home utilities 50.03
Cross street/directions to job site:SW 110's Ave. 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 I
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Install new double-check backflow preventer;renovate/upgrade existing manual Dishwasher 25.02
sprinkler system. Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Sue sample
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:Same Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:(503)620.5231 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:LJH LANDSCAPE&IRRIGATION Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Larry J.Hoekman
Roof drain(commercial) 12.51
Address:14210 SW Kimberly Dr. Sink/basin/lavatory 25.02
City/State/ZIP:Beaverton,OR 97008 Solar units(potable water) 62.54
Phone:(971)285.1691 Fax::(503)352.5432 Tub/shower/shower pan 12.51
E-mail:Tarry@ljhlandscapeandirrigation.com Urinal 25.02
Water closet 25.02
CONTRACTOR -
Water heater 37.52
Business name:LJH LANDSCAPE&IRRIGATION Water piping/DWV 56.29
Address:14210 SW Kimberly Dr. Other: 25.02
City/State/ZIP:Beaverton,OR 97008 Subtotal 31.27
Phone:(971)285.1691 Fax:(503)3523432 Minimum permit fee: $72.50 72.50
CCB Lie.:LCB 8792 31 )/f S Plumbing Lic.no.:11743 Plan review (25%of permit fee) n/r
State surcharge(12%of permit fee) 8.70
Authorized signatures , TOTAL PERMIT FEE I 81.20
Print name:Larry J.Hoekman Date 051072014 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.
1-1Building Tennits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10825 SW FAIRHAVEN WAY, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00156
George Heimos
1" febco model 850U, serial no. H14134
Violation Summary:
Inspector Contractor