Permit (60) q CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00046
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/02/2016
Parcel: 2S103CCO2000
Jurisdiction: Tigard
Site address: 12040 SW ROSE VISTA DR
Project: Hazard Subdivision: COLONIAL VIEW Lot: 15
Project Description: Installation of residential backflow preventer for irrigation system.
Contractor: LENNY'S SPRINKLER AND LIGHTING SERVICES Owner: HAZARD,JOHN GERALD&
PO BOX 2097 DARLINE GROGAN CO-TRS
BEAVERTON, OR 97075 12040 SW ROSE VISTA DR
TIGARD, OR 97223
PHONE: 503-403-9446 PHONE: 503-639-9561
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/02/2016 $31.27
Specifics: 1 12%State Surcharge- 02/02/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 02/02/2016 $41.23
Class of Work: OTR 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 UNC 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.
Plumbing Permit I V
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Building Fixtures "R=eceived .,
City of Tigard FEB 2 ?016 Date/By: .4ZI,�, Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 7
Phone: 503.718.2439 '&ffY9PT1,(A )t(tDate/By: Other Permit No.:
Inspection Line: 503.639.4 Date Ready/By: Juris: 1 0 See Page 2 for
Internet: www.tigard-or ING IAVLSJ() Notified/Method: Supplemental Information
im OF'W
El New construction 0 Demolition For special Information use checklist
Description I QtY. Ea. Total
Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
M71MGMY-OF COMTERMMN SFR(1)bath 31270
1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
El Accessory building 13 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler(_sq.ft.) Page 2
J011,SM 111400MUTM ANWIAWATM Site utilities:
Job site address: 12040 SW Rose Vista Dr 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.:__j Page 2
Suite/bidg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 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.:__j Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Bac 12.51
Backwater valve
UAW
Clothes washer 25.02
Installation of a double check valve Dishwasher 25.02
li
Drinking fountain 25.02
Ejectors/sump 25.02
0 p1tol"T1ti0iiii Expansion tank 12.51
Name:John Hazard Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12040 SW Rose Vista Dir Garbage disposal 25.02
City/State/ZIP:Tigard,OR.97223 Hose bib 25.02
Phone:(503)639-9561 Fax: Ice maker 12.51
Interceptor/ tease trap 25.02
13'
Business name:Lenny's Sprinkler and Lighting Services,LLC Medical gas(value:$ Page 2
Primer 12.51
Contact name:Lenny Cook
Roof drain(commercial) 12.51
Address:PO Box 2097 Sink/basin/lavatory 25.02
City/State/ZIP:Beaverton,OR.97075 Solar units(potable water) 62.54
Phone:(503)403-9446 Fax:: Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
Water heater 37.52
Business name:Lenny's Sprinkler and Lighting Services,LLC Water piping[DVrV 56.29
Address:PO Box 2097 Other: 25.02
City/State/ZIP:Beaverton,OR.97075 Subtotal 31.27
Phone:(503)403-9446 Fax: Minimum permit fee: $72.50
CCB Lic.:LCB 9136 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Lenny Cook Date:2/2/16 This permit application expires if permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.