Permit (191) 7PCITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2019-00198
TD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/09/2019
t }� Parcel: 2S104BA06600
Jurisdiction: Tigard
Site address: 13905 SW NORTHVIEW DR
Project: Declerck Subdivision: CASTLE HILL NO.2 Lot: 99
Project Description: Installing(1)backflow preventer for landscape irrigation.
Contractor: DENNIS SEVEN DEES LANDSCAPING Owner: DECLERCK, JOHN&ALISA
7355 SE JOHNSON CREEK BLVD 13905 SW NORTHVIEW DR
PORTLAND, OR 97206 TIGARD, OR 97223
PHONE: 503-777-7777 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/09/2019 $31.27
Specifics: 1 12%State Surcharge- 05/09/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/09/2019 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: (j6..A.A.. ...__, Permittee Signature: �t_:_ �V` ��C,
�1 Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicatio
LEIVED
Site Utilities FOR OFFICE USE ONLY
MAY 6 2019 Received `
111 11 . City of Tigard Date/By: s 1O\\A (Z 7 Permit No.: -WC&
11 13125 SW Hall Blvd.,Tigard,OR 97/2 W) OF f G Plan Review
Phone: 503.718.2439 Fax: 503.$ ( q 1 rp�p�ro�tDate/By: Other Permit No.:
, !,.A$1�'G �RG'Pt 1�J1M Re
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ®Other:Landscape New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:13905 SW Northview Drive Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: J Project name:John Declerck Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: J Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer I 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
install backflow preventer Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER , 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) 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
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Dennis'7 Dees Landscaping,Inc. WaterPip P�1 in WV 56.29
Address:7355 SE Johnson Creek Boulevard Other: 25.02
City/State/ZIP:Portland,OR 97206 Subtotal 31.27
Phone:(503)777-7777 I Fax:( ) Minimum permit fee: $72.50 72.50
CCB Lic.:5009 Plumbing Lic.no.:05LIBDI
Plan review (25%of permit fee) 0
State surcharge(12%of permit fee) 8.70
Authorized signature: Ili C�, n 'h/ /�(,,i l TOTAL PERMIT FEE 81.20
Print name:Vickie Mayfield'w� I�( ( !J CCC111"` Date:4/26/19 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.
1.\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13905 SW NORTHVIEW DR, TIGARD, May 23, 2019 at 10:29:13 AM
OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2019-00198
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Wilkins model 950x1t ser#4255185 irrigation backflow device located by water meter
approved with test report.
Violation Summary:
Inspector Contractor