Permit (39) CITY OF TIGARD PLUMBING PERMIT
'^ COMMUNITY DEVELOPMENT Permit#: PLM2016-00271
T I GAR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/24/2016
O
Parcel: 2S 104CA11000
Jurisdiction: Tigard
Site address: 13450 SW ESSEX DR
Project: Galida Subdivision: HILLSHIRE Lot: 110
Project Description: Residential backflow preventer for irrigation.
Contractor: PROGRASS INC. Owner: GALIDA, FRANKLIN R&MARILYN F
29895 SW KINSMAN RD 13450 SW ESSEX DR
WILSONVILLE, OR 97070 TIGARD, OR 97223
PHONE: 503-682-6076 PHONE:
FAX: 503-682-9876
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/24/2016 $31.27
Specifics: 1 12%State Surcharge- 05/24/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/24/2016 $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 to OUNC ailing 503.232.1987 or 1.800.332.2344.
Iss ed By: y Permittee Signature:
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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 RECEIVED
City of Tigard d Received
g Date/By: 02� i( PermitNo.: 14.1-001(o..009-7/
II 1111 13125 SW Hall Blvd.,Tigard,OR 9 ( 2 4 2016
(----„,. ...j.) .
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• Phone: 503.718.2439 Fax: 503.5 '1t�60 Date/By:an Review Other Permit No.:
Inspection Line: 503.639.4175 -
I 1(, V I:I) CITY OF T IGARD Date Ready/By: loris: la See Page 2 for
Internet: www.tigard-or.gov -Notified/M-ethod: Supplemental Information
TYPE OFRWORKIFEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I-and 2-family dwelling g ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB BITE INFORMATION AND LOCATION Site utilities:
Job site address:13450 SW Essex Dr. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Portland OR. 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I 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.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
Hesourn t 4OIf Backwater valve 12.51
Clothes washer 25.02
Backflow Device Installation Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
IBI PROPERTY OWNER I 0 TENANT. Expansion tank 12.51
Name:Frank Galida Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:13450 SW Essex Dr.
Garbage disposal 25.02
City/State/ZIP:Portland OR 97223 Hose bib 25.02
Phone:(503) 823-7517 Fax:( ) Ice maker 12.51
Interceptor/grease
{a APPLICANT ❑ CONTACT PERSONtrap 25.02
Business name:ProGrass Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Ken Christopherson
Roof drain(commercial) 12.51
Address:29895 SW Kinsman Rd. Sink/basin/lavatory 25.02
City/State/ZIP:Wilsonville OR. 97070 Solar units(potable water) 62.54
Phone:(503)682-6076 Fax::(503)682-4975 Tub/shower/shower pan 12.51
E-mail:kenc@prograss.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:ProGrass Inc. Water piping/DWV 56.29
Address:29895 SW Kinsman Rd. Other: 25.02
City/State/ZIP:Wilsonville OR. 97070 Subtotal
Phone:(503)682-6076 Fax:(503)682-4975 Minimum permit fee: $72.50
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Plan review (25%of permit fee)
CCB Lic.:68445 Plumbing Lic.no.:LCB 8079 -�p
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� State surcharge(12%ofpermit fee)Authorized signature: - TOTAL PERMIT FEE \?UPrint name:Ken Christopherson Date:5-18-16 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)