Permit (245) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00633
T E
(.1 AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/28/2016
Parcel: 25111 BC03300
Jurisdiction: Tigard
Site address: 10375 SW VIEW TER
Project: Johnson Subdivision: DOUGLAS HEIGHTS Lot: 8
Project Description: Installation of residential backflow preventer for irrigation
Contractor: WINTERBLOOM INC. Owner: JOHNSON, DOUGLAS E&SUE ANN LIV
14780 SW 98TH 10375 SW VIEW TERRACE
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503-598-0219
PHONE: 503-639-0737
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/28/2016 $31.27
Specifics: 1 12%State Surcharge- 12/28/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 12/28/2016 $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 . work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Util' otification -'ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
• direct questions to OU - --fling 503.232.1987 or 1.800.332.2344.
Issued By: k , / „LT Permittee S gnature:
Call 503.639.4175 by 7:00 a.m.for the next available ins ction date.
This permit card shall be kept in a conspicuous place on the job site ntil completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Site Utilities "°�E[11/41:,
a FOR OFFICE FSE Oy�Lv
City of Tigard Received
/ Permit No.:
13125 SW Hall Blvd.,Tigard,OR Plan Ry: //�/01
� fir' k ��lr!O��683
22016 Dan Review
1111 : Phone: 503.718.2439 Fax: 503.59896D Date/13y:
Other Permit No.:
T I( ARD Inspection Line 503 639 41701 y OF, i..i( Date Ready/By: 7uris: 1 See Page 2 for
Internet www tigard or gni l� Notified/Method
Supplemental Informahon
",` mF.2 , a'
w`` .._ .. `'. '" �a,
£' ; �� °
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I=1 New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
0 Addition/alteration/replacement 0 Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
° ' ''''' �=f �'1 ' . t SFR 1 bath
O 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
0 Master builderEach additional bath/kitchen 25.02
0 Other: m: Fire sprinkler(_sq.ft.) Page 2
li ' tP..."4`,
pw (.„ �I3 t-='�ib€`�,t l.f c3,! :` :' a. Site utilities•
Job site address: AP 3 95 ('h �`/!, 1 fee-, Catch basin or area drain 18.76
rig I _/ cg ,n 9'92 2 ' Footing
drain
line,or trench drain 18.76
2
City/State/ZIP: (� `/C,
/ Footing drain(no.linear ft.:� Page 2
Suite/bldg./apt.no.: V I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
/7?r r,t9itn r� fi
444 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: f Lot no.: Fixture or item:
Tax map/parcel no Backflow preventer / 31.27 3/. Z
12.51
� � �` l �J
�, '. :: . _ r.. . ., �� ;� Clothes washer 25.02
im irk /2� a /� ,ve
Dishwasher 25.02
G%y _ Drinking fountain 25.02
Ejectors/sump 25.02
1, at 1 rs} � a Ex ansiontank
.:r - ., ,. ..r ...
25.02
F _ 12.51
Name: C �a y "tit vnj Fixture/sewer cap f� //// l� Floor drain/floor sink/hub
Address: aQ25.02
Ui. t. lit-rD/I Garbage disposal 25.02
City/State/ZIP: 77 1 ��2 Z� Hose bib 25.02
Phone: ) ,3 � - a , Fax:( ) Ice maker
� �' � / tra12.51
�' . , grease p 25.02
Business name: rt�� ��� �n C Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: c cic
F� /1,7_6_ Roof drain(commercial) 12.51
Address: /1/780 JG/� / r1/ Sink/basin/lavatory 25.02
City/State/ZIP: tc-- /y /Q` 7 72 Solar units(potable water) 62.54
Phone:( ) ,.�Z Fax::
( ! ) Tub/shower/shower pan 12.51
E-mail: ,e/7 C bock_ C 0044 Urinal
Wcn tr.���dh2�� 25.02
Water closet 25.02
�. , __ .. � .a 37.52
Business name: ,,.��/
�a K Q f fauVe Water piping/DWV 56.29
Address: Other:
25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
LCB Lic.: �!// Plumbing Li .no.: Plan review (25%of permit fee)
j � � State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE V,a-en
Print name: �i�L Q G`j Date: /272.13/49 This permit application expires if a permit is not obtained within 180 days
�` SCJ /L� 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%ygB)