Permit (30) CITY OF TIGARD PLUMBING PERMIT
� COMMUNITY DEVELOPMENT Permit#: PLM2019-00360
Date Issued: 09/10/2019
T I i;,1 ft D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135CD02702
Jurisdiction: Tigard
Site address: 11715 SW 95TH AVE
Project: Trout Subdivision::HERS ADDITION TO GREENBURG HE Lot: 6
Project Description: Backflow preventer for landscape irrigation.
Contractor: PICON PACHECO Owner: AUDRY TROUT
25170 S OBERLANDER LANE 9577 SW MOUNTAIN VIEW LN
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503-632-3366 PHONE: 503-703-6775
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/10/2019 $31.27
Specifics: 1 12%State Surcharge- 09/10/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 09/10/2019 $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 no started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires yo to follow the r les adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-00 -+090. You m. obtain a copy of the rules
or direct questions to OUNC • calling 503.232. ••7 or 1.800.3y 344.
Issued Bj - Permittee 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
Building Fixtures Q L:w , ,; _,n mit 01-1-1( L. i SL. OM.1
City of Tigard Received /1 /� / 4 (r;'s„�G�7„I/� 3<
DlItelBy: 7 v`"�'vAf fjL
13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 DditBBy: Other Permit No.:
11 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 ther: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
X1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
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: I`7/3" Stv qs--6 �6 Catch basin or area drain I8.76
City/State/ZIP: �/ vDV v A, �,�VZ Z 2 I�ywell,leach line,or trench drain 18.76
Q 3 Footing drain(no.linear ft.:_J Page 2
Suite/bldg./apt.no.: I Project name: fl2cu 7 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Std LL /S : 12 * 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer i 31.27
DESCRIPTION OF WORK Backwater valve 1 12.51
( IC Clothes washer 25.02
-440,,I I�PIOI
I � W Dishwasher 25.02
kjl K 34CgRati q 2,i/d L Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 't 1� Fixturedsewer cap 25.02
"`c'' v G tit-
Floor drain/floor sink/hub 25.02
Address: 117s� (' 9 .�,�hhhe,, Garbage disposal 25.02
City/State/ZIP: vCr .D2 417 y23 Hose bib 25.02
Phone:ao_y) 703 /7,5 - Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:
j/ (R � � ) Medical gas(value:$ ) Page 2
!-_-D pIde� � / Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: 7® d)e. 1/3 _ Sink/basin/lavatory 25.02
City/State/ZIP: ge06j0� Ty1 0/2_ Solar units(potable water) 62.54
Phone:S03) to 32, 317(0(* /� Fax::(Sea) 470, 3367 Tub/shower/shower pan 12.51
E-mail: tfr c/rrs Iiz i�e1fAe. �41'X 44 4)14 Urinal 25.02
"'t! �v✓ Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: � art /Le/,q, blAixefihr' Water piping/DWV 56.29
�?re.414,1
Address: 1 a0 113 Other: 25.02
City/State/ZIP: ,2.4.06,04,/ ��7 /^ 70 7 J/ _ Subtotal
Phone:LO) to 33 4,4, Fax:(503)(o3 2,..334,2 _ Minimum permit fee: $72.50 -
Plan review (25%of permit fee)
CCB Lic.: �3 S3 P1> bi>sg�-"ie'nts•:L C?y?y' State surcharge(I2%of permit fee)
Authorized signature: / TOTAL PERMIT FEE
Print name: 1 Y 4 Date: 4//40191019This permit application expires if a permit is not obtained within 180 days
r i[ S-1 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/O21COM/WEB)