Permit 14 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00091
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/08/2018
Parcel: 1 S 134DC 13000
Jurisdiction: Tigard
Site address: 11477 SW SUZANNE AVE
Project: Mission Meadows,Lot 2 Subdivision: MISSION MEADOWS
Project Description: Irrigation backflow. Lot: 2
Contractor: CONTOUR LANDSCAPING Owner: MISSION HOMES NW
12485 SW TOOZE RD PO BOX 1689
SHERWOOD, OR 97140 LAKE, OR 97035
PHONE: 503-682-1302 PHONE: 503-593-5324
FAX: 503-682-1302
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/08/2018 $31.27
Specifics:, 1 12%State Surcharge- 03/08/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 03/08/2018 $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: ie-'4J,
r c,./. /.2..t*.a,.. ,
Permittee Signature: 4,,,,v- fpm pt_le- j�`�
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.
Plu mb n Permit Application
Building Fixtures
MAR 8 2018
INCity of Tigard 1.0It 01 I.I(`I: t.SI O 11'
• 13125 SW Hall Blvd.,Ti Cf6ry 't' Received
■ Tigard,OR 97 a t i e nr s � DateB 3 de
Phone: 503.7182439 Fes; ,� 1 n i °G '"9 a y. l y • y. `mss Permit N
Inspection Line: 503.639.4175 03.54:. t Plan Review �"�� n/�= "JCI jI
1 1 G R p Date/By:
Internet: Line:g 03 39.41 Other Permit)413-77:20/7e03.5 I
Date Ready/By:
TYPE OF WORK Notified/Method:
® See Page 2 for
Supplemental Information
s_ ew construction FEE SCHEDULE
❑Dem°lition
For s,ecial in°rotation use checklist
0 Other: Des '.tion
New I-2-family dwellingsft. ��� Total
1111 Addition/alteration/replacement
(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION
111111111112111111111.
►' and 2-family dwelling SFR(1)bath al.❑Commercial/industrial MN
SFR(2)bath 312.70
SFR(3)bath
❑Accessory building
❑Multi-family
Each additional bath/kitchen 11111 25.02 11111500 32
❑Master builder 1111111111❑Other:
JOB SITE INFO p s 1111111122311.111111
11111111111RMATION AND LOCATION sprinkler(___sq.ft.)
Job site address: i/ t,�
-4 Site utilities:
6 L �1 # Catch basin or area drain 11111 18.76�--1L-- t sem- MI, line,or trench drain _
Suite/bldg./apt,no.: Drywellleach 18.76
oject name: 11111111111
Footing drain(no.linear ft.:`)
Cross street/directions to job site: .w r' " -i r.�
Manufactured home utilities 11111111Manholes 50.03 MN
1111111.
Rain drain connector =�
18.76
Sanitary sewer(no.linear ft.:-__._) _ _
Storm sewer(no.linear ft.:___._)
Subdivision:
Water service(no.linear ft.:____) IIIIIIIIIZTIIMIIIIIIII
T maision: el no.: Lot no.: Fixture or item:
Backflow prcwentermili_®_
DESCRIPTION OF WORK Backwater valIN
1111 "4111112111M5 � r� �� _; Clothes washer _
l
IT
Dishwasher ailIl25.02 _
. � Drinking fountain 11111111 111111 25 0225.02 -
❑ PROPERTY OWNER Ejectors/sump 25.02 _
0 TENANT 111111 _
)/'y� (� /�� ��-y Expansion tank _�_
Name:ess: ( el Alu) Fixture/sewercap _
A
Ai '� Milli
Floor drain/floor sink/hub 25.02
City/State/ZIP: �+ a 25.02 _
" i 4ijj , 0 GarbagedisposalPhone:( ) it ��� � Hose bib 111111 25.02 _
►�i Ice maker Mil 25.02 r
Business name: ❑ CONTACT PERSON Interceptor/grease trap _®
1111111 25.02
Contact name: Medical gas(value:$ ) _�=
11111111111
Address: _�_
Roof drain(commercial) _02
Sink/basin/lavatory _
Phone:( ) Solar units 25.02 _
(potable water) 11111 62.54
111111111.
E-mail:[ r) v Tub/shower/shower pan _®
Ivo '�� 't'1/ Urinal _
CONTRACT a R 25.02 1111111111
eA Water closet _
,� �/4Water heater 25.02 _
mon
Address: -4,144 r®
_ - �� Water piping/DWV
111111111
City/State/ZIP:/ZIP: •
Ai"� 1111111111
56.29
Other: _
.�/ ' 'fis.L3/ "�/410 25.02
Phone:( ,
` 111110211111
U Subtotal 1111111111
Minimum permit fee: $72.50 MIA
11111.11
4 Plumbing Lic.no.:
Authorized signature: n Plan review (25%of permit fee)
Print name: / State surcharge(12%of permit fee) IMIll
�� �'vIMI TOTAL PERMIT FEE Irl,
Date: 3/-1 This permit applica8on expires ita t
afar it bo been accepted180 as complete.
Permns�PL1NU•Pennrtgpp.doc tlirot/O9 *Fee methodology set by Tri-County Building Industry Service Board. `
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