Permit TIGARD CITY OF Vf'i PLUMBING PERMIT
1,
is COMMUNITY DEVELOPMENT Permit #: PLM200901J309
TIGARD! 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2009
Parcel: 2S102CD05600
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Jurisdiction: Tigard
Site address: 13882 SW 95TH AVE
Subdivision: FLETCHER WOODS Lot: 6
Project: Fletcher Woods
Project Description: Install backflow for irrigation.
Owner: FEES
MCADAMS, JAMIE & SUSAN Quantity Description Date Amount
24300 NW GREEN MOUNTAIN RD
BANKS, OR 97106 1 ea Backflow Preventer 10/27/2009 $31.27
PHONE: 503-780-5542 1 12% State Surcharge - 10/27/2009 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 10/27/2009 $41.23
Contractor: Plumbing
DIAMOND LANDSCAPE INC
14333 NW HWY 47 •
BANKS, OR 97106 -
PHONE: 503 - 320 -7049
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
1 MST Ersn Cntrl 503 - 681 -4444
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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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ^ I \ . ,, b „ '\ Permittee Signature: ''' A PP
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
;7ct, 23 09 09:05a Mike Soe-rrEIVED 503-324-3026 p.2
Plumbing Permit Application
Building Fixtures OCT 2 3 nog
City of Tigard Received Permit No.:QLm2 •OV
■ 13125 SW Hall Blvd., Tigard, OR 97220TY OF TIGAIZD Plan Review
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Phone: 503.639.4171 Fax: 503.51ERLDING DIVISIO Da1y: Other Permit No.: Wri 200q,
GB
a Inspection Line: 503.639.4175 Date Ready/By: ruris: Id See Page 2 for
Internet: www.tigwd-or.gov Notified/Method: Supplementallnforms6on
TYPE OF WORK FEE" SCHEDULE
❑ New construction ❑ Demolition For s pedal hmformagon use cher:M&
Description QTY. I Ea. Total
❑ Addition/alteration/replacement ® 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 building ❑ multi-family SFR (3) bath 500.32
Each additional balh/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler C_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13882 SW 95th Ave. 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 R.: ~ Page 2
Suite/bldg./apt. no.: Project name: Manufactured home utilities 50.03
Cross steet/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: Lnt nn.: Fixture or item:
Tax map/parcel no.: Baci flow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Install baekflow assembly -
Dishwasher ^25.02
Drinking fountain -Y 25.02
Ejcctors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Jamie Mcadams FixtureJsewer cap 25.02
Address: 13882 SW 95t° Ave Floor drain/floor sink/hub 25.02
Garbage disposal 25,02
City/State/ZIP: Tigard Or. 97224 (lose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/greasctrap 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: ( j Fax:: ( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Diamond Landscape Inc. _ Water piping/DWV 56.29
Address: 14333 Nw Iltwy 47 Other: 25.02
City/State/ZIP: Banks Or. 97106 _ Subtotal
Phone: (503) 320-7049 Fax: ( ) Minimum permit fee: $72.50
CCB.Lie.: LCB 7445 Plumbing Lic. no.: Plan review (25%ol'permit fee)
State surcharge( 121/o of permit fee)
Authorized signature: TOTAL PERMIT FEE 8e.2
Print name: John Soper Date: 10 23-09 This permit application eapirrs if a permit is not obtained within I80 days
after it has been accepted as rompleUs
•Fee methodology set by Tri-County Building Industry Service Board.