Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00098
a �, < ' Date Issued: 03/12/2018
T I GRD R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �.
Parcel: 2S110BA11500
.9"—'. Jurisdiction: Tigard
Site address: 14248 SW 118TH CT
Project: Medallion Meadows,Lot 10 Subdivision: MEDALLION MEADOWS Lot: 8
Project Description: Backflow preventer for irrigation. 3/26/18:REPRINTED to change address.
Contractor: SUMMIT LANDSCAPE LLC Owner: JT ROTH CONSTRUCTION INC
PO BOX 3610 12600 SW 72ND AVE#200
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-380-7618 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/12/2018 $31.27
Specifics: 1 12%State Surcharge- 03/12/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 03/12/2018 $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: 111.1P -----Permittee Signature: p ^
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.
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00098
7 1AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/12/2018
Parcel: 2S110BA11500
Jurisdiction: Tigard
Site address: 14188 SW 118TH CT
Project: Medallion Meadows Subdivision: MEDALLION MEADOWS Lot: 8
Project Description: Backflow preventer for irrigation.
Contractor: SUMMIT LANDSCAPE LLC Owner: JT ROTH CONSTRUCTION INC
PO BOX 3610 12600 SW 72ND AVE#200
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-380-7618 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/12/2018 $31.27
Specifics: 1 12%State Surcharge- 03/12/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 03/12/2018 $41.23
Plumbing
Class of Work: OTR
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. Y.0 m.y(Wain a copy of the rules
or direct questions to OUNC by calling 503 . .:•i. .2344.
Issued By: I
� � � PeFaiittg�Si�nature:
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
Buildin Fixtures FOR OFFICE USE ONLY
City of Tigard Received A., '977-
�" y
Date/By: f+ r// Permit No.: f'c e el Y, -t )(/
Ihi 4 13125 SW Hall Blvd.,Tigard,OR 97223 pp /"60 4yVi(J l 7 D
g �} 1 r)"t- Plan Review
= Phone: 503.718.2439 Fax: 503.598.1960 N�` Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIG A R I) s , "'i.4 ' ate Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov { t" 1',k,, y",'q "1 Notified /Method: Pr Supplemental Information
TYPE OF WO i TG l ISION P,' '''''''I': FEE* SC1IED LE
For special information use checklist
Ad New construction ['Demolition For f
Description I Qty. Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONsiiibCT ON '' SFR(1)bath 312.70
LIEL1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE'iNFORMATION AND LOCATION ,, Site utilities:
Job site address: �� / Catch basin or area drain 18.76
/ f( ffg D 1` L i Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1-,,y,,,, -,.
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: #1.2, .t t o"v (a- --.c:- c S
Manufactured home utilities 50.03
Cross street/directions to job site: j/Si]t ,c, e4 4 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
�n Water service(no.linear ft.:_) Page 2
Subdivision: G'ilk4_1, 1A-14-:, 2,c. utcS I Lot no.: /0 Fixture or item:
Tax map/parcel no.: Backflow preventer I 31.27 3/47
$ '. '- Backwater valve 12.51
� Clothes washer 25.02
ele-4: 64.rtn) l''- ��"-/�� 'J Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER K 4'•N Expansion tank 12.51
D E ANT �� �
-D y
Name: -I ('L Gc�,5+r, e.T,Z*-� Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
r _% 0 APPLICANT QONI'I'4CT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
NTRi1CTOR Water closet 25.02
- Water heater 37.52
Business name: S.. Yt„-v n t A-- ,C,,,..,L\S Lc,. \ L . Water piping/DWV 56.29
Address: Z, �,, „ +i -.miff'- Other: 25.02
City/State/ZIP: ,AS" c,-1?....,_ cl 7! .)-3 Subtotal 3/ ,17
Phone:(SC3) :j 0-- (v 1 ,; Fax:( )
Minimum permit fee: $72.50 71,5-0
Plan review (25%of permit fee)
CCB Lic.: Eli bing-tic-no.: L c-LX 4- C ip,
State surcharge(12%of permit fee) ,
Authorized signature: lit/ TOTAL PERMIT FEE 8,1 ig
Print name: ► ,' �l Date: 3 0 y 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)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qry• Fee(ea)• Tot*a Sell* ootage, „: Permit Fee.
Footing drain 1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee
t
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or s Qty, Fee(ea) each additional$100.00 or fraction thereof,to
" 1
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. -"Plan'ga 'for Pl :Nbing Installationirk
Quantity by Fixture Type"x Plan review is required for any of the following.
Fixture Typefor. Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4" 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14248 SW 118TH CT, TIGARD, OR, 97224 April 13, 2018 at 11 :31 :25 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00098
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
Backflow devise test report collected at building plumbing final inspection.
Violation Summary:
Inspector Contractor
ipilCITY OF TIGARD PLUMBING PERMIT
'` Permit#: PLM2018-00098
12 ' COMMUNITY DEVELOPMENT
• • t Date Issued: 03/12/2018
T I CiA l�D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 t '; Parcel: 2S1106A11500
P-7— Jurisdiction: Tigard
Site address: 14248 SW 118TH CT
Project: Medallion Meadows,Lot 10 Subdivision: MEDALLION MEADOWS Lot: 8
Project Description: Backflow preventer for irrigation., 3/26/18:REPRINTED to change address.
Contractor: SUMMIT LANDSCAPE LLC Owner: JT ROTH CONSTRUCTION INC
PO BOX 3610 12600 SW 72ND AVE#200
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-380-7618 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/12/2018 $31.27
Specifics: 1 12%State Surcharge- 03/12/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 03/12/2018 $41.23
Plumbing
Class of Work: OTR
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: C/
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.
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00098
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/12/2018
T fatht. Parcel: 2S110BA11500
Jurisdiction: Tigard
Site address: 14188 SW 118TH CT
Project: Medallion Meadows Subdivision: MEDALLION MEADOWS Lot: 8
Project Description: Backflow preventer for irrigation.
Contractor: SUMMIT LANDSCAPE LLC Owner: JT ROTH CONSTRUCTION INC
PO BOX 3610 12600 SW 72ND AVE#200
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-380-7618 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/12/2018 $31.27
Specifics: 1 12%State Surcharge- 03/12/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 03/12/2018 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y•u m-y(Wain a copy of the rules
or direct questions to OUNC by calling 503. r v." .2344. `�_ I
MOP
Issued By: PermittdeS.ignature:
Call 503.639A175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures �. FOR OFFICE USE ONE\'
Received
City of Tigard Permit No.: '-y
41 13125 SW Hall Blvd.,Tigard,OR 97223 2 ,;;1,, Date/By: 3 / /� A li�{��
#� t 1, Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 1\11/AP, Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD 1'4 '4, 'i, ry s ate Read/By kris: H See Pagee 2 for
Internet: www.tigard-or.gov l t ,,." ,
Notified/Method: Supplemental Information
TYPE OF WO' i %DIVISION FEE*''$CHEDIfLE ,`:
I 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)
CATEGQit ' NSTRUCTION SFR(1)bath 4E1,1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATIO14 AND-LOCATION` Site utilities:
Job site address: Catch basin or area drain 18.76
! '/(ee3 5 i/S/1
City/State/ZIP: 1-,,),,,,,, Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: A.2,N:.((iaki fa,e-c�Q:;,„;5
Manufactured home utilities 50.03
Cross street/directions to job site: i/?1.4- . !4 A.a j r_ 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: fiI' 1��ttE�G-i4,r \ c,� c,.�S' Lot no.: /0 Fixture or item:
Tax map/parcel no.: Backflow preventer I 31.27 30:7
,,.7
Backwater valve 12.51
� ` . DESCRIPTt1 1¢ QRK' it
.. A°.,.
� Clothes washer 25.02
eleki" 6*ri c) -�j.ei rPI 1.-) i Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
-.,. It,Ty OWNER I;h _ 0 TENANT
Expansion tank 12.51
Name: 51--- 12,014_ (z,A., .4-r uc.T,�}� Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT* 0 it T PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
f Water closet 25.02
CONTRACT01<t :fi.A.., x. "
`' Water heater 37.52
Business name: Sim N,,,tint 4... 1 G,,,.,.N.SLr.-12" \ \(_ . Water piping/DWV 56.29
Address: 2, --,, (-) '_- - Other: 25.02
City/State/ZIP: \A.As,c)t.-t-�, (1,-32_ q 3 I .)-3 Subtotal 36 „Y7
Phone:(S L,3) :j`6 0--1-61 f..'' Fax:( )
Minimum permit fee: $72.50 7),,co
Plan review (25%of permit fee)
CCB Lic.: moo.: 4:14_ c/F., State surcharge(12%of permit fee) e 70
Authorized signature: '�It) TOTAL PERMIT FEE'
0
_ 'eJ.J''
Print name: L -. ,j,( l I Date: 3i,, �(� This permit application expires if a permit is not obtained within 180 days
G 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)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square FoQt e Permit Fee;
Footing drain-1s`100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
• ' each additional$100.00 or fraction thereof,to
Oth6 Inspetions or Fees Qt i. Fee{ea) Total and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Instalti tion
Quatitly by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ ,` Please check all that apply.
Work Performed: Capped Added Relocate .`
Baptistry/FontElAny new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4>,
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
CITY OF TIGARD PLUMBING PERMIT
111 4 COMMUNITY DEVELOPMENTPermit#: PLM2018-00098
T f i ;E I<.I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 "'1 t ,e': Date Issued: 03/12/2018
' ` ' Parcel: 2S110BA11500
'' - /(r '/.. Jurisdiction: Tigard
Site address: 14248 SW 118TH CT
Project: Medallion Meadows,Lot 10 Subdivision: MEDALLION MEADOWS Lot: 8
Project Description: Backflow preventer for irrigation. 3/26/18:REPRINTED to change address.
Contractor: SUMMIT LANDSCAPE LLC Owner: JT ROTH CONSTRUCTION INC
PO BOX 3610 12600 SW 72ND AVE#200
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-380-7618 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/12/2018 $31.27
Specifics: 1 12%State Surcharge- 03/12/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 03/12/2018 $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 OUN . calling 51 .232.1987/r 1.800.332.2344.
Issued By: ,
Permittee Signature: , /
i ,,- -::;
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.