Permit n CITY OF TIGARD PLUMBING PERMIT
IIII1 � ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00270
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/17/2015
Parcel: 2S114BB07900
Jurisdiction: Tigard
Site address: 16295 SW 104TH AVE
Project: Craig Subdivision: SWANSON'S GLEN Lot: 20
Project Description: Installation or residential backflow preventer for irrigation.
Contractor: OWNER Owner: CRAIG, SARAH&GUY
SARAH CRAIG 16295 SW 104TH AVE
16295 SW 104TH AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-312-8121 PHONE: 503-312-8121
FAX:
FEES
Quantity Description Date Amount
ea Backflow Preventer 08/17/2015 $31.27
Specifics: 1 12%State Surcharge- 08/17/2015 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/17/2015 $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 Notificati•i 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•.-stions to •.•C b .. ing 503.232.1987 or 1.800.332.2344.
1 1
Issu=• By: Perm ittee Signat •- MI&
I41M11•111■■111111.
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
City of Tigard RECEIVED Received , /� a�
DateB ( � / Permit No.. ( d
Mil a 13125 SW Hall Blvd.,Tigard, 97223 Plan Review
Phone: 503.718.2439 Fax: 503.5 J> 16q 7 2 015
Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 /� l7 1 Date Ready/By: luris: See Page 2 for www.tigard-or.gov
-
f ,, -,-; -.^^r�1t'��,� Notified/Method: Supplemental Information
�f' 1 ti...AR'-J
TYPE Q . jt ..J7 1 J i' • FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
,,-,� CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
►-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 1:1 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: //#2'f55 5N/ to it Ave Catch basin or area drain 18.76
--� Drywell,leach line,or trench drain 18.76
City/State/ZIP: 9gn/,OR 972Zy
Footing drain(no.linear ft.: Page 2
Suite/bldgJapt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: gym rigorkairs /` o✓de 6‘.4/74 an Manholes 18.76
1401/#11 Ave. 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 / 31.27
DESCRIPTION OF WORK Backwater valve 12.51
1�
J Clothes washer 25.02 i
Oloil torte ivj fqn 9/ 14-ern AV�Attleilla!✓ dewre Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 1 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fa v: ( Ii Ice maker 12.51
IE APPLICANT 1E t;ONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: &Orate 69.4<9
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) _ 62.54
Phone:(003) $J2.2121 Fax::( 1 Tub/shower/shower pan 12.51
E-mail: 4 ra ti cm 9 w eiwiail.e0A, Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 0 i/1 )€� Water piping/DWV 56.29
Address: `v Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 70/.5 U
CCB Lie.: Plumbing Lic.no.:
Plan review (25%of permit fee) _r
State surcharge(12%of permit fee) '.70
Authorized signature: 444424 /� TOTAL PERMIT FEE �r'�
Print name: J' 4/, era ` Date: / This permit application expires if a permit is not obtained within 180 days
C f�/ //� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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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
16295 SW 104TH AVE, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00270
George Heimos
NOTE: 1" Febco Model 850 Serial Number HD68703
guy_craig1@msn.com
Violation Summary:
Inspector Contractor