Permit (178) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00033
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/28/2016
Parcel: 2S 111 BB00400
Jurisdiction: Tigard
Site address: 14135 100TH AVE
Project: RIVER PRESERVATION LLC Subdivision: TIGARDVILLE HEIGHTS Lot: 13
Project Description: Backflow for irrigation.
Contractor: LIVING COLOR LANDSCAPE CO Owner: RIVER PRESERVATION LLC
PO BOX 514 PO BOX 513
WILSONVILLE, OR 97070 WILSONVILLE, OR 97070
PHONE: 503-678-3364 PHONE:
FAX: 503-678-5981
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/28/2016 $31.27
Specifics: 1 12%State Surcharge- 01/28/2016 $8.70
Plumbing
Type of Use: MF
41 ea Minimum Fee Adjustment- 01/28/2016 $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 at the time of each inspection.
01/26/2016 11:50 5036785981 LIVING COLOR LANDSCA PAGE 02
Plum,bine Permit Application
Building Fixtures
City of Tigard � '�� p�at� � /1- �� �� Perm;tNo•: /� ' ,
13125 SW Hall Blvd.,Tigard, FjPlan
Pbvne: 503.718.2439 Pax: 50 - 960 evuw Other Permit No,:
inspection Line, 503.639.4175 ��� a�et' g�dyigy hula et See par ipr
Internet: wWw.tigard-or-gov 3x �. 0tifiad/A4ethod F Su IameNtal information
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Aesa; ion I Ea. Total
❑.A,ddition/alteration/repiamnept []'Other: New 1-2-banally dwells (includes 100 0,for each utility coni ion)
SFR(1)bath 312.10
[� 1-and 2-family dwelling ❑Commercial/industrial SFPR(2)b437,78
❑A=ssory building Multi-family It(3)bath
h 500..32
Each additivusl bath/kitchen 25.02
❑Master builder ❑mer- Fire sprinkler(_sq.f1.) Page 2
t1 r y, 4 site militias:
Job Site address: Catch basin m'area drain 18.76
'OV/
�� Dryvvell,leach line,or trench drain 18.76
city/statr./Z P:
Footing drain(no.linear R:_,,,,,) Page 2
SuitoNdgda no.: name:
pt, Projeot / lV1HrtU.THLYyTCII 1uNr1C utilities 50.03
Crass street/directions to job site: Manholes 18.76
Rain drain oomtector 18.76
Sanitary sewer(no.linear ft.: .. Page 2
Storm sewer(nv,linear f1.:_) Page 2
Water service(no.linear ft- �) Page 2
Subdivision: Lot no.: Fixture or item:
Twa mop/parcel no- Backflow preventer 31.27
y�y Backwater valve 12.51
A .',•r!F'�' l"` .^'+.±`r}2{'x` ,,]`'ri w,+J�: \ °�Y��•nr
..' .. - Clothes Washer 25.02
C d I7ishwasber 25.02
Drinking fountain 25,02
Ejectorsfsump 25.02
Expansion tank 12.51
Name: Fixture/sewer cap 2.5.02
Address, t/C/ 'r Floor drain/;floor sinkthub 25.02
Garbage disposal 25.02
city/StatclZIP: f U/ ( Q Q Hose bib 25.02
Phone:('503) 5_ ! eFax:( ) Ice Maker 12.51
.1fi."� A ,r��R' 1�,�.-S Y 1 ap;] �.FI•.(?f � R�;-ix: Inert eptrx/grease trap 25.02
Business atone / /1j"/j Q S�^ - Medical PS(value:$ ) Page 2
Primer 1151
Contact name:
Roof drain(commercial) 12.51
Address: SirtkAmWAavntory 25.02
City/state/ZIP: / f Solar units(potable water) 62-54
Phone:(,-r 3i 6 7 •_33 C)(/ Fax—( pj) 6° TYtb/sltowcr/sl►ownr pert i 2.51
E-mail: Urinal 25.02
Water closet 25.02
{�: .i •"� ,JCA, k1 ,J`t,te •. _.. i• r a j, `t_..
'. ', ' , ..,,•,.
Water heater 37.52
Business name: , _ 117d5 Water piping/DW V 56.29
Address: Other. 25.02
City/St"WZIP: r ( /C(.J}� Ej Subtotal
Minimum permit fee: $72.50
Phone;(Fo ) l^ax:( "> OF-577 I
CCD Lir"; Plumbing Lic_no Pin review (25%of permit fee)
Of State surcharge(12%of permit fee)
ff,70-
Authorized sigtatum; ' TOTAL PERMIT F16E ft _Z0
Print name: I?ate: .l•,Hermit kpplivaltou eapiree ifs peraett is not ootaimA within W days
efkr it Tris been accepted as complete.
"Fee methodology set by Tri-Cowty Hwlftg l+adustry 5c,i.Bewrd.
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