Permit (231) CITY OF TIGARD PLUMBING PERMIT
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1 I ---.. . . COMMUNITY DEVELOPMENT Permit#: PLM2019-00320
T"I(_1 A R.f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2019
Parcel: 1 S135BD02200
Jurisdiction: Tigard
Site address: 9572 SW ANNA BELLE CT
Project: CLARK Subdivision: ASH CREEK VILLAGE Lot: 8
Project Description: Installing backflow preventer for landscape irrigation.
Contractor: UNIQUE ART LANDSCAPE Owner: CLARK, PAMELA J
PO BOX 2111 9572 SW ANNA BELLE CT
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-709-4222 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/08/2019 $31.27
Specifics: 1 12%State Surcharge- 08/08/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/08/2019 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
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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 32.1987 or 1.800.332.2344.
Issued By:,,,.. ."'
Permittee Signatur
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
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Site Utilities FOR OFFICE 1 '. 1.-• O\L\
City of Tigard Received
AUG - 8 2019Datemy: ---7,-7/ Aef .14-,Ni/toe/1-40 g2.
. . 13125 SW Hall Blvd.,Tigard,OR 97223
11111
Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 , Pate/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD ,,,,;.:_!:, , .;,..., ,.., ,,e ,qatI Ready/By: Juris. F6 See Page 2 for
Internet: www.tigard-or.gov ' ICItitified/Method: Supplemental Information
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12t New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
El Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
Al_and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
El Accessory building 1=1 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATIONSite utilities:
.
/71 -
Job site address: 1 5 -1- 2._ ./y .. 13
ri rt 0, ,:,,ile e_ ../_ Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -n 90_1,- .,,,f ,,... 9., '2 2-3
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:
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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer I 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
I q Si-CI-110-boil c,--r oaci<-flovu cle.v; EL Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
CX PROPERTY OWNER 1 0 TENANT - Expansion tank 12.51
Fixture/sewer cap 25.02
Name: '.-i--.)A1-Ne (ck.._ 0 (cc.,1,-k-_
Floor drain/floor sink/hub 25.02
Address: ci) i.4_-z_ c; 1,,,) 4\v-kvvrk &Li.e__ 0._ -(---.
Garbage disposal 25.02
City/State/ZIP: -11
0C.(-4--Ci (j)\......... 974_2, 2 1.:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
14 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
.
Medical gas(value:$ ) Page 2
Business name: 01/Lig i)e_ /4..v4.. Leti,idce (L/.C? 1 n c
Primer 12.51
Contact name: ,j-i)a ki 0 r-c-Lc.o Roof drain(commercial) 12.51
Address: P, C)- 80x „7.- ii / Sink/basin/lavatory 25.02
City/State/ZIP: Orence-\ OA--I y 0-K. CI 3-C.i-1-S-- Solar units(potable water) 62.54
,...1 - , ---
- - Phtme:(SM)- -.7 61:1._ q 2-2 2._-- - rax-:,'.(-S02) -7 13 -s-w4 TtibtSbowertshower pan 12.51
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E-mail: I etJt et.c.>.'C cLp.e. .11 ei.1.. .* ct
ci u e ,k--I-taike„ike_a_t2e. Urinal 25.02
0 Oni
CONTRA
ortai Water closet
25.02
Water heater 37.52
Business name: 1),ft_i I ut Ili'+ L‘L/tti'SA I
, c_ ettZ /- . 4 C- Water piping/DWV 56.29
Address: p, c, 13 6 v ,2- / / I Other: 25.02
City/State/ZIP: 0 'b
rPo e--1,-) & t( 01Z clictis--- Subtotal
Minimum permit fee: $72.50
Phone:(,5,. ,.-5) 7c,e7_4 2 2 2_ Fax:(5G) 723 -s-tf,--7 9
Plan review (25%of permit fee)
CCB Lie.: Le ICI) -- CP, i / Plumbing Lie,no.:
State surcharge(12%of permit fee)
Ce /3 0
Authorized signature:
TOTAL PERMIT FEE
Print namez____) c.) Date: S.1. '/ 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:\BuildingTermits WLMU-PermitApp doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9572 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2019-00320
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
1 " Wilkins model 350, serial number A808310 located under entry.
Violation Summary:
Inspector Contractor