Permit CITY OF TIGARD PLUMBING PERMIT
V
COMMUNITY DEVELOPMENT Permit#: PLM2016-00011
13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Date Issued: 01/13/2016
Parcel: 2S 1038812800
Jurisdiction: Tigard
Site address: 12275 SW ANN CT
Project: SITARA Subdivision: LAKE TERRACE NO.2 Lot: 21
Project Description: Backflow for irrigation.
Contractor: DRAKES 7 DEES Owner: SITARA, SUNITA LIVING TURST
16519 SE STARK ST 12275 SW ANN CT
PORTLAND, OR 97233 TIGARD, OR 97223
PHONE. 503-256-2223 PHONE:
FAX 503-256-0865
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/13/2016 $31.27
Specifics: 1 12%State Surcharge- 01/13/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 01/13/2016 $41.23
Class of Work: ALT Plumbing
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:
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 al the time of each inspection.
Plumbing Permit Application
Site Utilities FOR
VReceived
City of Tigard Dale/By: �� I Permit Na.:P I
13125 S50 Ilall Blvd.,Tigard,50 X16 plan Review
Phone: 503.71 8.2439 Fox: 50 60^��g 'L PCO Dmnr Ycrmit Na.:
1^ Dale/B
a Inspection Linc: 503.639.4175 \ //,� pie heady/fly: roru ® Sen Puge 2 for
Internet: www.tigard-or.gov J ,�T olified/Methal: Supplemental lnfermadan
.. .. TYPE OF WORK r 1,01, FEE-SCHEDULE:
❑New construction ❑ I Forspecial in armodon ase cheeA((sz
�A Descri tion Q Ea. Total
❑ her.
®Addilion/alteration/replacemenl lY^Jt 1� New I-2-family dwellings(includes 10011.for each utility connection)
CATEGORY OF CONsmucnON Y' ` q SFR(1)bath 312.70
-M-1•and 2-family dwelling ❑Commercial/industrial tie SFR(2)bath 437.78
ElAccessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
E] Mister builder El Other: Fimsprinklcr(_sq.R.) Page
]OB SITE INFORMATION AND LOCATION Site utilities:
Job site address: s- �+ Catch basin or arca drain 18.76
Urywell,leach line,or trench drain 18.76
City/Stale/ZIP: CC l
- Fooling dram(no.liner fl.:_) Page
Suite bldg./apt.no.: Project name: {
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain dmin connector 18.76
Sanitary sewer(no.linear R.:_) Page 2
Storm sewer(no.linear fl.:_) Paget
Wnta service(no.linear fl.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax maid/parcel no.: Backilow prevcoter t' 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT - Expansion tank 12.51
Name G1Ci Fixturelsewer cap 25.02
FloardmiNfloor sink/hub 25.02
Address: A-f\ 'T Garbage disposal 25.02
Cit /Slate/ZIP: c�`_ n
Y \ 1G�,-�C�-,L/�`,1�i. t L`!_.. � }lose bib 25.02
Phone:1e6i 5 ):j Lys C6, 47 Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTAcr PERSON Interceplor/gretse trap 25.02
Business name 1 t 1 ✓ `-� Medical gas(value:S ) Page 2
_ Prima 12.51
Contact name: s Roofdrain(commercial) 12.51
Address: \ jlC"� `-J�.- . c'�� �t� �� ��
Sink/basin/lavatory, 25.02
City/State/ZIP: -� ( �� �`? _ t,. �� Solar units(potable water) 1 62.54
Fax::, Tub/shower/shower pen 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRAcI'OR.
water heater 37.52
Business name: Waley piping/DWV 56.29
Address: �- .,/ _ r�._ I / ,- J Other. 25.02
City/Slate/ZIP: � a l �J I- Subtotal
Fax:L ) Minimum permit fee: S72.SU la• t
CCB Lie.: Plumbing Lic,no.: Z �„ Plan review (25%of permit(ee)
t h�/', Stale surcharge(12%of peril fee)
Authorized si : II Gy
�azure7 �V� V" ',t-' TOTAL PERMff FEE )
Print❑untie: ���.;��(Ad-f,tit+i„- DIIIC: j 1 1 This permit stpptica Hao...1,.if.permit b npl obt4ln.d whhin 190 days
titer,It has been pceepted as complete. •�
-Pee mmbudol.gy set by TrbCoanly Building lndusuy Service B"Z\ I,
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