Permit ,, CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00309
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/31/2017
Parcel: 2S103AC09500
Jurisdiction: Tigard
Site address: 11410 SW FONNER ST
Project: Brown Subdivision: 2014-023 PARTITION PLAT Lot: 1
Project Description: Irrigation backflow for sprinkler system.
Contractor: LBD LANDSCAPING LLC Owner: LHL HOMES INC
PO BOX 3189 11580 SW 67TH AVE
CLACKAMAS, OR 97015 PORTLAND, OR 97223
PHONE: 503-631-8755 PHONE:
FAX: 503-631-8735
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/31/2017 $31.27
Specifics: 1 12%State Surcharge- 07/31/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 07/31/2017 $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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: , Permittee Signature:
X979/04 l Pii-7-70,1
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 CC'''''
Site Utilities ofTi and \ EC "'--i\jFOR OFFICE USE ONLY
- }ter g DateiBed
II 13125 SW Hall Blvd.,Tigard,OR 972p q 1 `Z017
Date/ByReview `� 4k/(71--- Permit No/04/1„20/'7_4e90:309
f� Plan Review
Phone: 503.718.2439 Fax: 503.59 Pap
DateBy Other Permit No.:
Inspection Line: 503.639.4175 ri a Date Read B tuns: 0 See Page 2 for
TIGARD Y�/ ,' 1tAG{I+�G� Ready/By: B
Internet: www.tigard-or.gov (j',I l V V�"I�R®N Notified/Method: Supplemental Information
a� FEES HEDULE . ,
o New construction 0 Demolition For special information use checklist
Description 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
cx1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
TOB SEI`E INFORMATION AND LOCATION Site utilities:
Job site address: //./..//o -SLI/ fe3vac, ,5/ Catch basin or area drain 18.76
City/State/ZIP: 7 Drywell,leach line,or trench drain 18.76
6 . � f7 23
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Beipwil 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: ' Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer / 31.27 3/..1
Backwater valve 12.51
DESC TION OF WG) I
?i5.04/' Clothes washer 25.02
//V')7 - L- A/4'L4 Sys'&A-t Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
NROI;ERTY t, +1Eii { Q TENAN f' Expansion tank 12.51
� Fixture/sewer cap 25.02
Name: �a/4/ A}00L/A
'l Floor drain/floor sink/hub 25.02
Address: //y/0 ,.,/,/ /52'd-/&49i7 Garbage disposal 25.02
City/State/ZIP: // 61 '7.•,-..z.....- Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
yAPPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: K>-i {07p f�o � Medical gas(value:$ ) Page 2
�Aj J Primer 12.51
Contact name:/2(34/ r
��� i � Roof drain(commercial) 12.51
Q
Address: AO 4O4j 3/ Sink/basin/lavatory 25.02
City/State/ZIP: 1 gt - OCT' 0er , Airj''' Solar units(potable water) 62.54
Phone: Fax: : / Tub/shower/shower pan 12.51
E-mail: it e /bdk 5v4 Urinal 25.02
Water closet 25.02
CONTRALTO
Water heater 37.52
Business name: AM) 44%,....a c1'/A/-' 4-1.-e.--- Water piping/DWV 56.29
Address: pd 6-011 3/s/y Other: 25.02
City/State/ZIP: 0A !of 9'7r)/� Subtotal ,3/..7
1 Minimum permit fee: $72.50 50
Phone:(g9 )��� n55 Fax:( ) 4.)11):23...1.-
CCB Lic.: 7385 5 C Plumbing Lic.no.: /114.51")__., Plan review (25%0of permit fee)
State surcharge(12/o of permit fee) S":11)
Authorized signature/ii 1.. 1 1 TOTAL PERMIT FEE g/.
III This permit application expires if a permit is not obtained within 180 days
Print name:AVef i .... pi,ji Date: 1251?
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pemrits\PLMU-PemtitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)