Permit CITY OF TIGARD PLUMBING PERMIT
11111
COMMUNITY DEVELOPMENT Permit#: PLM2019 00460
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/20/2019
Parcel: 2S 111 ACO2901
Jurisdiction: Tigard
Site address: 9500 SW MURDOCK ST
Project: Templeton Elementary School Subdivision: None Lot: None
Project Description: Backflow preventer installation near the main Murdock Street entrance.
Contractor: AFFINITY NW LANDSCAPING LLC Owner: TIGARD-TUALATIN SCHOOL
8536 SW ST HELENS DR SUITE C DISTRICT 23J
WILSONVILLE, OR 97070 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-807-8213 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/19/2019 $31.27
Specifics: 1 12%State Surcharge- 11/19/2019 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 11/19/2019 $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: � 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
� _ fret ti, i �i � � ,
Site Utilities E i ti s ' FOR OFR(FxJ SE O'Nt
City of Tigard Received
NOV 2 01 Date/By: 1t/i /i i Permit No.: , 77',/, i c�-_0)=2it,i/)
iik +� 13125 SW Hall Blvd.,"Tigard,Olt 97223 `' plan Review
i :s Phone: 503.718.2439 Fax: 503.598 196QF DatelB Other Permit No.:
Inspection line: 503 639 4175 TIGARD ✓IEI�Y OF' &1Cr1)-, Date Ready/By: Sans Sec Page 2 for
Internet: www.tigard-or.gov i li11 i 91 ri°t:J /lC-..' Notitied/Method: 071-. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
New construction ❑Demolition For special information use checklist `
Description i Qty. I Ea. !
Total
❑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
❑ 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 47.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ►; Other:School Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9500 SW Murdock Street Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, OR 97224
Footing drain(no.linear ft.: -,_) Page 2
Suite/bldg./apt.no.: Project name:Templeton Elementary School 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Install of backfiow device near the main entrance off Murdock Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
/ PROPERTY OWNER I El TENANT Expansion tank 12.51
Name:Tigard -Tualitan School District Fixture/sewer cap ..__ 25.02
Floor drain/floor sink/hub 25.02
Address:6960 SW Sandburg `__""'_
Garbage disposal 25.02
City/State/ZIP:Tigard, OR 97223 Ilosebib 25.02
Phone:( 503)431-4000 Fax:( ) Ice maker 12.51
❑ APPLICANT u [0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Affinity NW Landscaping Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Ashley Winchell
Roof drain(commercial) 12.51
Address:8536 SW St Helens Dr, Suite C Sink/basin/lavatory 25.02
City/State/ZIP:Wilsonville, OR 97070 Solar units(potable water) 62.54
Phone:(503 )826-5124 Fax: :(844 )335-8258 Tub/shower/shower pan 12.51
E-mail:ashley@afnitynw.biz Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Affinity NW Landscaping Water piping/DWV 56.29
Address:8536 SW St Helens Dr, Suite C Other: 25.02
City/State/ZIP: Wilsonville, OR 97070 Subtotal 31.27
Phone:(503 )826-5124 Fax:(844 )335-8258 L Minimum permit fee: $72.50 72.50
Plan review (25%of permit fee)
CCB Lie.:210308 l'lua,l,irtg IA.Ay.. LCB: 9448
e State surcharge(12%of permit fee) t:
Authorized signature: r x TOTAI. PERMIT FEE f6'f
Print name:KoreyWinchell - Date:11/12/2019 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by TO-County Building Iiidustiy Service Board.
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