Permit CITY OF TIGARD PLUMBING PERMIT
,111 COMMUNITY DEVELOPMENT Permit#: PLM2020-00235
T t GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/18/2020
Parcel: 2S 103BA00114
Jurisdiction: Tigard
Site address: 11825 SW ANN ST
Project: EASTMAN Subdivision: LERON HEIGHTS Lot: 14
Project Description: Backflow preventer for irrigation.
Contractor: MORTAR AND PETAL LLC Owner: EASTMAN, DAVID G
2005 SE 143RD AVE 11825 SWANN ST
PORTLAND, OR 97233 TIGARD, OR 97223
PHONE: 503-757-1735 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/11/2020 $31.27
Specifics: 1 12%State Surcharge- 06/11/2020 S8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 06/11/2020 $41.23
Class of Work: ALT Plumbing
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 952-001-0010through 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: e) Permittee Signature: 69 A✓ c ne/I/
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 AnDlication
Building Fixtures
City of Tigard RECEIVED Received
DateBy: Permit No..
r 13125 SW Hall Blvd.,Tigard,OR 97223 ` N / ��'^��
�N 4 2020 Plan Review
Phone: 503.118.2439 Fax: 5°3.598.196 I1 Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD Internet: www.tigard-or.gov Date Ready/By: Res See Page for
CITY OF TIGARD Notified/Method: ', ,/ Supplemental Information
TYPE OF wo UILDING DIVISION FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description j Qty. I Es. I 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 ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
0 Multi-Gamily
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION A1]i ATION Site utilities:
Job site address: f i 4 a S` S E //n A,pr�s f^- Catch basin or area drain 18.76
City/State/ZIP: I� I� C)kY'^(a_q•apt 3 Drywell,leach line,or trench drain 18.76
7 Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: Project name: E a5'I-r►'v^ '‘ Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
$ I") / 21 SI' I ✓e. to ,Arne St 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 1 31.27 )
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Bt^e k . lot* �)P �+Gr' IC 1 rri4tton Dishwasher 25.02
s y§-tern • UPc4,100) ,,,J 1l` be inn vat ve Drinking fountain 25.02
I)o x I in geol. C(0 K +o f iw.t Coo r Ejectors/sump 25.02
EgPROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:
G.J l t, .-YIll' "1 Fixture/sewer cap 25.02
" n �S s A n G r 1 Floor drain/floor sink/hub 25.02
Address: 4 A 71 Garbage disposal 25.02
City/State/ZIP: T j uJ OK R -gsg3 Hose bib 25.02
Phone: ( ) Fax:( ) Ice maker 12.51
g APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ! -t p y-i.`„(- c"-".d1/4- f 0aL (l L Medical gas(value:$_) Page 2
Primer 12.51
Contact name: a f iw\ t o o0okr' v•H- Roof drain(commercial) 12.51
Address: 4 t)0.s sr J UI3 JCL eiar . Sink/basinilava[ory 25.02
City/State/ZIP: RV f l i„j O q �. 7 3 Solar units(potable water) 62.54
Phone:(Sp 2�) S ( S' Fax: :( ) /�J Tub/shower/shower pan 12.51
E-mail: M 0&re Cre" pe f,per L (L C CW i Y)al:(. tom Urinal 25.02
J Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water 1 m WV 56.29
Pp P,/D
Address: Other: 25.02
City/State/ZIP: Subtotal 31,1)
Phone:( ) Fax:( )
Minimum permit fee: $72.50 , 57)
CCB Lic.: Le b 9 y 4 $ / Plumbing Lic.no.: Plan review (25%of permit fee)
Authorized signature: J 3 1 ? 'tl)-o State surcharge(12%of permit fee) -,J
TOTAL PERMIT FEE {p�
Brl (A)0D el,(d A ‘�3/ao ID This permit application expires if a permit Is not obtained within 180 day
Print name: t t Date: 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/WEB)