Permit ip 4 CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00299
TIGARD: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/15/2008
PARCEL: 2S103BD -05500
SITE ADDRESS: 12679 SW 116TH AVE ZONING: R -4.5
SUBDIVISION: HUNTER'S GLEN LOT: 011 JURISDICTION: TIG
PROJECT: HERBST
Project Description: Installation of residential backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JAMES HERBST
12679 SW 116TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/15/2008 $36.25
[TAX] 12% State Surch 7/15/2008 $4.35
Phone : 503 -579 -9556 Total $40.60
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notif nter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rul s or direct q stions • OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue By: 6 c ' I// / Permittee Signature: .�i.
.�_ _..tai:
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.
, . v
,Plpra�bing Permit Application
Building Fixtures FOR. OFFICE USE ONLY •
Received t/A_-� Q ,
III City of Tigard 7 , D Permit No.: ' L (�(J -p
II 1 3125 SW Hall Blvd., Tigard, OR 97223 Date/By:
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read /B ®See P e 2 for
Internet: www.ti
TIGARD. and -or. ov y Y g
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 6. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 12679 SW 116 Ave Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Herbst sprinkler system Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job ste: Walnut
Manholes 16.60
From Main Street head West on Pacific Hwy, turn right on Walnut Street, then
Rain drain connector 16.60
left on 116 Ave. (approx. 1 mile) Job site is two blocks up on the right. Sanitary sewer (no. linear R.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: Hunter's Glen 1 Lot no.: 11 Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.: R2062979
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2
Installing sprinkler system in front yard. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER l ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: James A. Herbst
Expansion tank 16.60
Address: 12679 SW 116 Ave Fixture /sewer cap 16.60
City /State /ZIP: Tigard, OR 97223 Floor drain /floor sink/hub 16.60
Phone: (503)579 - 9556 Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: '
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Ct,0 / i� ) « Water heater 16.60
Address: / Other:
City /State /ZIP: Subtotal /
[
- Minimum permit fee: $72.50 g EI
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 w P . l�
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: � State surcharge (12% of permit fee) • 35
TOTAL PERMIT FEE O.
Print name: James A.Tlerbst Date: 07/11/2008 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: \Building \Permits \PLMF- PermitApp.doc 12/27/06 440-46 16T( 1 0/02/COM/WEB)