Permit CITY OF TIGARD PLUMBING PERMIT
1111 I COMMUNITY DEVELOPMENT Permit#: PLM2015-00036
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2015
Parcel: 2S 102AB01000
Jurisdiction: Tigard
Site address: 11970 SW LINCOLN AVE
Project: BARBER Subdivision: KIMBERLY ADDITION Lot: 19
Project Description: Backflow for irrigation.
Contractor: MONTERREY IRRIGATION Owner: BARBER, NORMA A
4715 SE 94TH AVE 11970 SW LINCOLN AVE
PORTLAND, OR 97266 TIGARD, OR 97223
PHONE: 503-539-0677 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/04/2015 $31.27
Specifics: 1 12%State Surcharge- 02/04/2015 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 02/04/2015 $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 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: "• - •• mittee Signature: I
ti
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 ,►�. Received L. Permit No.:
Ihi
. • 13125 SW Hall Blvd.,Tigard,OR23 ti01�
Date/B : �� G/ho20 GS-♦ ,
Plan Review
Phone: 503.718.2439 Fax: 503.598.19 4. Other Permit No.:
fQ Date/By:
Inspection Line: 503.639.4175 �J Date Read /B Juris ® See Page 2 for
TIGAItI) r �� Ready/By: S
Internet www.tigard-or.gov i �,V 0 Notified/Method: �Co Supplemental Information
TYPE OF WORK' �� �/ FEE* SCHEDULE
®New construction ❑Demolition 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
t:t I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
Accessory building SFR(3)bath 500.32
❑ ry g ❑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:11970 SW Lincoln Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site:Greenburg 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: Lot no.: Fixture or item:
Tax map/parcel no.:
Backflow preventer 1 31.27
3/ Fi
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Front Yard Sprinkler System
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Norma Barber Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11970 SW Lincoln Ave
Garbage disposal 25.02
City/State/ZIP:Tigard,Oregon 97223 Hose bib 25.02
Phone:(503)620-2095 Fax:( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Norma Barber
Roof drain(commercial) 12.51
Address: 11970 SW Lincoln Ave Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,Oregon 97223 Solar units(potable water) 62.54
Phone:(503)620-2095 Fax::( ) Tub/shower/shower pan 12.51
E-mail:ccmbarber @hotmail.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Monterrey Irrigation Water piping/DWV 56.29
Address:4715 SE 94th Ave Other: 25.02
City/State/ZIP:Portland,Oregon 97266 Subtotal 3/. '
Phone:(503)568-9604 Fax:( ) Minimum permit fee: $72.50 7,5)
CCB Lic.:Icb#8428 /1 3)l f 5 Plumbing Lie no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) 70
Authorized signature: /)) A 1 TOTAL PERMIT FEE• , _
Print name:Norma Barber Date:)////„5/ 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.
I:\Building\Permits\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 Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11970 SW LINCOLN AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00036
David Young
Scrape drain rock back to provide 12" clearance under backflow devise.
1" Wilkins model 350, serial # A388805
Violation Summary:
Inspector Contractor