Permit (60) INCITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00446
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2016
Parcel: 2S111 BD04700
Jurisdiction: Tigard
Site address: 9926 SW MURDOCK ST
Project: Murdock Street Partition,Lot 1 Subdivision: 2016-005 PARTITION PLAT Lot: 1
Project Description: Backflow preventer for irrigation system
Contractor: TRUSCAPES Owner: SAGE BUILT HOMES LLC
21600 NW AMBERWOOD DR 1815 NW 169TH PL, STE 1040
HILLSBORO, OR 97124 BEAVERTON, OR 97006
PHONE: 503-707-0213 PHONE:
FAX: 503-352-4607
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/16/2016 $31.27
Specifics: 1 12%State Surcharge- 08/16/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/16/2016 $41.23
Class of Work: OTR Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rul-s adopted b the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-009* . You may btain` a co,f of ye ules
or direct guc OUNC b or 1.800.332.2344. ' ' ) /
// m• 503.232.1987
By: • illigliMillt,
Issued B ,/A / Permittee Signature: - .
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Site Utilities RE. CEI E
City of Tigard Received //&' ��13125 SW Hall Blvd. TigardOR 97AjG 1 6 2016 PlanDateRe: (-- A0, Permit No.: /0L1-4:96/6"...00 94/,Phone: 503.718.2439 Fax: 503.598.1960 Pian Review
_
Date/By: Other Permit No.: HI rd e/ OlP�Q1
T I G A R D Inspection Line: 503 639.4175 CITY OF T�GARD Date Read B L
Internet: www.tigard-or.gov BU
t � Notified/Method: Juns.
! See Page 2 for
( 't Y G DIVISION
I, I ION Supplemental Information
. . l"tTr W , larta�7i: P1t " ", 14;$ 3p:
®New construction 0 Demolition For special information use checklist
Description Qty. Ea. j Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CA +Gfl< Y=(I COIY t1J+w Al SFR(1)bath 312.70
►1 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE TIO AND wcATION Site utilities:
Job site address:9926 SW Murdock St Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Murdock Street Partition
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.:Lot 1 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
1) }N'Ov:WoRI Backwater valve 12.51
Installation of backflow device for irrigation system. Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Q PttER' 'oVvlt 1 t Q TENS Expansion tank 12.51
Name:Sage Built Homes LLC Fixture/sewer cap 25.02
Address:1815 NW 169th Pl,Ste 1040 Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Beaverton,OR 97006 Hose bib
25.02
Phone:( ) Fax:( ) Ice maker 12.51
, L A 0 CONTACF 1 ERSoN;r " Interceptor/grease trap 25.02
Business name:Truscapes Medical gas(value:$ ) Page 2
Contact name:Stacey Whitfield Primer 12.51
Roof drain(commercial) 12.51
Address:21600 NW Amberwood Dr.
Sink/basin/lavatory 25.02
City/State/ZIP:Hillsboro,OR 97124 Solar units(potable water) 62.54
Phone:(503)707-0213 Fax::(503)352-4607 Tub/shower/shower pan 12.51
E-mail:stacey@truscapes.com Urinal 25.02
cos AG'r'oR
Water closet 25.02
Business name:Truscapes
Water heater 37.52
Water piping/DW V 56.29
Address:21600 NW Amberwood Dr. Other: 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal
Phone:(503)707-0213 Fax:(503)352-4607 Minimum permit fee: $72.50
CCB Lic.:LCB#7962 ' umbing ic. o.: Plan review (25%of permit fee)
/ /f�� NamState surcharge(12%of permit fee)
Authorized signature: �/ w,. r �l� TOTAL PERMIT FEE S'`,
Print name:Stacey Whitfield Date:8/16/16 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)