Permit (67) � f
CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2017-00331
13125 SW Hall Blvd.,Ti Date Issued: 08/17/2017
T[tal and OR 97223 503.718.2439 9
Parcel: 2S 112AA00900
Jurisdiction: Tigard
Site address: 14140 SW 72ND AVE 100
Project: Polycast Subdivision: 1992-007 PARTITION PLAT Lot: 1
Project Description: Installation of(1)backflow preventer and(1)backwater valve.
Contractor: LOVETT INC Owner: ICON OWNER POOL 1 WEST LLC
PO BOX 86280 BY RYAN
PORTLAND, OR 97286 PO BOX 460169
HOUSTON, TX 77056
PHONE: 503-737-8423 PHONE:
FAX: 503-288-1630
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/17/2017 $31.27
Specifics: 1 ea Backwater Valve 08/17/2017 $12.51
1 12%State Surcharge- 08/17/2017 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 29 ea Minimum Fee Adjustment- 08/17/2017 $28.72
Type of Const: Plumbing
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 dire questions . OUNC by calling 503.232.1987 or 1.800.332.2344.
Is ued By: , O 4 / Permittee Signa
Call 503.639.4175 by 7:00 a.m.for the next available inspecti. 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.
i
i
Plumbing Permit Applic � 1
' �.,
Site Utilities ,..i , FOR OFFICE USE ONLY r
s
City of Tigard - y 17 Received
Iiiii 13125 SW Hall Blvd.,Tigard,'OR 54.1,1_ x 'T AateBy: « /7 j Permit No �/y��7 D�
C Phone: 503.718.2439 Fax: 52345%19(11:1, Pan Review Other Permit No.:
i Date/By:
Inspection Line: 503.639.4175 1. 3.
1IUARD �� b` 1�ateReady/Ay Ions �See Page 2 for
Internet: www.tigard-or.gov
supplemental Information
i" otrficd/M
:"a.:a'� v^'`,...,.. ::r ;:: gaggEl ., ? iw i : JPL* §V.,. jJ'Lea ..i`;
Notified/Method:o I
A.
❑New construction For special information~roe checklist.
❑Demolition P
Description i Qty. I En. 1 Total
1ZOiddition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
Itw 4 v �,; {g'} a 4 CATEGORY'OIt CONrSSTRiJG 'IOPI '�.. SFR(1)bath 312.70
❑ 1-and 2-family dwelling ) 2Commercial/industrial SFR(2)bath 437,78
0 Accessory building ❑Multi-faintly SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 OtheT
Firc sprinkler
14111111111.-*ST.�t~.LNFQIl;M`A,'T.IOJt A.NA LQGA1Jd N 1 ' Site utilities: ft.) Page 2 -
sq.
. - tr 4 1'
Job site (address: • Catch basin or area drain 18.76
�'� SO �� � � Dry\veli,leach line,or trench drain 18.76 i
City/State/ZIP: `�'� / p � (��/ 71.
d + ` /6 X 91!Z-L/ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: /�ti 0 1'�roject name: 00it
L/ (#1S 7 Manufactured home utilities 50.03 1
Cross street/directions to job site: 1lin, 3(')d - AILd /eft Manholes 18.76 r
Rain drain connector 18.76 t
• Sanitary sewer(no.linear ft.: ) Page 2 r
7
Storm sewer(no.linear ft.: ) Page 2 ili
t
i
Water service(no.linear It.: ) • Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no Backflow preventer ,;214 / 31.27
O , Backwater valve G
1251 AESCIIITQN QFRQRI
Clothes washer 25.02.----PIS--V7,0t %")e ii ' r,o 4 j Kce �/ok e9 Dishwasher 25.02
AAA, et 1 Ol .v7 . ds 'I1 i '
Drinking fountain 25.02
Ejectors/sump 25.02 i
4x 10 1'�t,O)P RTY OWNER l a Oi `.' Expansion tank 12.51 1
Name: f �v);4- £ S6)1 13146 S Fixture/sewercap 25.02
L/t' v WO 1 Floor drain/floor sink/hub 25.02
Address: Pe 0, l 6 1't �J 5 t)0 C
Garbage disposal 25.02
City/State/ZIP: Pb)-- ,i4 A- 1'j 7 U' Tao i Hose bib 25.02
Phone ( i ) ; Z 3 11 ) $ i Ice maker 12.51
onimme t] AICAr • a LtQINATfp $Q Interceptor/grease trap 25.02
. : P, , y
Business name: �> t✓ Medical gas(value:$ ) Page 2
Contact name: 1 1 S^h�
Primer 12. 51
Address: te��1 ��\� Z '� II
Roof drain(commercial) 12.51
y Sink/basin/lavatory 25.02
City/State/ZIP: " ill'A,11/ /.../ ) t Solar units(potable water) 62.54 I
Phone:( U!) g,s ✓I 2,1,8' Fax::( ) Tub/shower/shower pan 12.51 t
•E-mail: i`VNt Urinal 25.02
C�tE
f k't/ S Q !o V e+f Se'V IGFs r G6h') I
CTRACTOR;:
Water closet 25.02 11
ON
' Water heater 37.52
Business name: �.o ; f 4'1 j WaterPg/
rP in D W V 56.29
Address: / �. t 1y)0 r 0 Other: 25.02
City/State/ZIP:?64,1, (Wt.,., 17Z/3r Subtotal
Phone:(50 5) ' Fax: Minimum permit fee: $72.50 7,2.50 j
7� Plan review (25%of permit fee)
CCB L.ic.: l+a S SO-i Plumbing Lie.no.: (.j.� 120
State surcharge(12%of permit fee) p, 0
Authorized signature: /�� Meth) T'O'TAL PERMIT FEE oft)
Print name: C( !/t,�j �i } Q{� Date: ,,_,J y j`7 This permit application expires if a permit is not obtained within 180 days
v rt.t.ur' after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Sol-Vice Board.
T:\nuilding\Permitslr'LMU-PcnnitApp.doe I0/01/09 440-4616T(IO/02/COM/witB)