Permit (172) CITY OF TIGARD PLUMBING PERMIT
IIIR.. COMMUNITY DEVELOPMENT Permit#: PLM2019 00184
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/02/2019
Parcel: 1S135CD01600
Jurisdiction: Tigard
Site address:
Project: Canyon Court Subdivision: GREENBERG HEIGHTS Lot: 3
Project Description: Backflow preventer for water quality facility irrigation meter.
Contractor: TRUSCAPES Owner: SAMM-MILLER LLC
21600 NW AMBERWOOD DR 1327 JAY ST
HILLSBORO, OR 97124 WEST LINN, OR 97068
PHONE: 503-707-0213 PHONE:
FAX: 503-352-4607
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/02/2019 $31.27
Specifics: 1 12%State Surcharge- 05/02/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/02/2019 $41.23
Plumbing
Class of Work: ALT
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 :.. - ,4.
Issued By: - ..'tee Signature:
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, ..
Site Utilities
City of Tigard . . Received5 - Permit No.:
41 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ///Gj /24415Z1/19....66)/1-,r
� Plan ReviewNI �"jl
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Permit Other No. C3�(// 7„ 0" 70
/y:n �
T I C.ARD Inspection Line: 503.639.4175 + Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
fi..« t ,... '!.: �W !.
`ae: 'iF ySFf f� moi. :i:". .p :i44,4',i,::4. -it46 “ -„,,,i.,.7-4;v4 :4,%:?,,,- ,:
®New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/re lacement Other r\^ ,v1 / 1
❑ p � d'� 71� 4 "f�t New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
VI 1-and 2-family dwelling Lo Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building tulti-family
Each additional bath/kitchen 25.02
❑Master builder I )ther:
Fire sprinkler( sq.ft.) Page 2
zt 11 L Site utilities:
Job site address:11 Ave Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Canyon Court Manufactured home utilities 50.03
Cross street/directions to job site:SW 98'and SW Greenburg 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:Canyon Court 1 Lot no.: Fixture or item:
Tax map/parcel no T�1 ytet'f' `� `3 /n&/‘.14:-)
/14 Backflow preventer 1 31.27 3 . ?--2
"" d �r f' (� Backwater valve 12.51
,-, Clothes washer 25.02
Installation of a Backflow preventer for the water quality facility irrigation
Dishwasher 25.02
meter. Drinking fountain 25.02
Ejectors/sump 25.02
►e 40, ��0 4, * Expansion tank 12.51
Name:SB Land Development,LLC Fixture/sewer cap 25.02
Address: 1815 NW 169th Place,Suite#1040 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Beaverton,OR 97006 Hose bib 25.02
Phone:(503)969-8298 Fax:( ) Ice maker 12.51
>a, 44 h4 :,i �,!, Interceptor/grease trap 25.02
Business name:Same as owner Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Cale Doney
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(503)969-8298 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:caled@sagebuilthomesllc.com Urinal 25.02
Water closet 25.02
r 2. _X9
, :. TyZ, � , ,� r ; Watarheater 37.52
Business name:TruScapes WaterP�
Prn iP WV 56.29
Address:21600 NW Amberwood Dr Other: 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal 3/,)-,
Phone:(503)531-9216 Fax:( ) Minimum permit fee: $72.50 )‘,,Z, z)
Plan review (25%of permit fee)
CCB Lic.:LCB#7962 Plumbing Lie.no.:12245
State surcharge(12%of permit fee) 7c)
Authorized signature: TOTAL PERMIT FEE I(/ ))
Print name: C��G 97„....----2
Date: This permit application expires if a permit is not obtained within 180 days
/�ZCi7� 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/WER)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
May 17, 2019 at 8:43:18 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00184
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Febco model 850 ser#96282 located west side of water Q facility by sidewalk approved
with test report.
Violation Summary:
Inspector Contractor