Permit (36) CITY OF TIGARD PLUMBING PERMIT
1111 • COMMUNITY DEVELOPMENT Permit#: PLM2016-00218
Tigard OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 04/20/2016
Tli;;\I<.l� 9
Parcel: 2S102CC03200
Jurisdiction: Tigard
Site address: 10340 SW HILLVIEW ST
Project: REAVIS Subdivision: FRELEON HEIGHTS NO.2 Lot: 15
Project Description: Backflow preventer for irrigation.
Contractor: OWNER Owner: REAVIS, SCOTT B&JULIE
SCOTT REAVIS 10340 SW HILLVIEW ST
10340 SW HILLVIEW ST TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-260-2031 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/20/2016 $31.27
Specifics: 1 12%State Surcharge- 04/20/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/20/2016 $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 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: So
} Permltte _Signature: `
Call 03.639.4175 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 Tigard6°-\144'14ii811
Received / --
`J g DateBy p I(or en-
[/1 J Permit xo.:It a rL y�j < ((J
13125 SW Hall Blvd.,Tigard,OR 97 Plan Review -Q YJtLJ[" �. Q
IN
Phone: 503.718.2439 Fax: 503.598.1960 q 0 ��1� y Other Permit No.:
Date/BInspection Line: 503.639.4175 PQ� it k Date Ready/By: .[itis: ® See Page 2 for
L Internet: www ti ardor. ov L�
g 8 ���, l ed/Method: p Supplemental Information
TYPE OF WORK ,'�1 '` �����"r1 FEE; SCHEDULE
❑New construction 0 1:� .116 a114" 3 For special information use checklist
i Description I Qty. I Ea. I Total
nrAddition/alteration/replacement ❑ i 1- : New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
igf 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /03 yL/ Catch basin or area drain 18.76
0 SMJ I (t/l e vJ �'f • Drywell,leach line,or trench drain 18.76
City/State/ZIP: T iq/1,-ef D 2. 9 7.2.2-3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: J l Project name: Manufactured home utilities 50.03
Cross street/directions to job site: j'Oa 2A 4- M C D on n id car?-. Manholes 18.76
/02-A4 - /J ) I I Vt'e b+/ -.=C71,, 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.:p320 0 Fixture or item:
Tax map/parcel no.: Z S l.-C C - Backflow preventer r 31.27 3/„1.7
DESCRIPTION OF WORK Backwater valve 12.51
n tt irk+` f lm � Clothes washer 25.02
� CDishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: sC 0 rt �e 4.-,J Fixture/sewer cap 25.02
rr II Floor drain/floor sink/hub 25.02
Address: /03 SV0 \ri t/ !T r It V/e of XI-, Garbage disposal 25.02
City/State/ZIP: T9R rd l O .. 5'7 .2._.3 Hose bib 25.02
Phone:(563) 0?6 0 - 0703/ Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: a/ Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 3i.„L7
Phone:( ) Fax:( ) Minimum permit fee: $72.50 79? .5
CCB Lie.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) Q, 70
Authorized signature: o e„LTOTAL PERMIT FEE 'S 1 ;0
This permit application expires if a permit is not obtained within 180 days
Print name: SCC 7r -Wp,4 it/f Date: .t/x 0//44 after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.