Permit CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit #: PLM2010 -00281
T 1 G AR L) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 2S104AD05800
Jurisdiction: Tigard
Site address: 12896 SW SEVILLA AVE
Subdivision: WALNUT CROSSING Lot: 5
Project: Walnut Crossing
Project Description: Backflow for irrigation.
Owner: FEES
CASA TERRA LLC Quantity Description Date Amount
PO BOX 1082 •
CLACKAMAS, OR 97015 1 ea Backflow Preventer 08/26/2010 $31.27
1 12% State Surcharge - 08/26/2010 $8.70
PHONE: Plumbing
41 ea Minimum Fee Adjustment - 08/26/2010 $41.23
Plumbing
Contractor:
4 A LANDSCAPE & IRRIGATION INC
63391 OMER DR
BEND, OR 97701
PHONE: 541 - 419 -3003
FAX: 541 - 312 -8793
Type of Use: SF
Class of Work: ALT 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 -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: Permittee Signature:
. 0.1 01 %
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.
Aug 2410 12:19p 4A Landscape & Irrigation 5413128793 p.2
Plumbing Permit
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City of Tigard
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13125 SVi(Hall Blvd., Tigard, OR 97223 ® r i/ 0 - ,e ,
Phone: 503.639.4171 Fax 503598.1960 "' = t1" g°L1E
Inspection Line: 503.639.4175 �� 4 r _4' ; DatdBy. OthrTPecmitNo.:
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TYPE OF 'WORK See Pale S for
scppkmentat information
FEE* 11 FEE SCE per.
New construction ❑ Demolition kor spedailaformaioionasechecklist
❑ Addition/alteration/replacement 0 Other: Description 1 1 Qty 1 Ea. I Total
New 1- 2- famityldwe1Iings (includes 100 ft. for each utility connection)
CATEGORY OF .CONSTRUCTION : : SFR (1) bath r 312.70
.1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building [3 Multi-family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other. Fire sprinkler ( 1 sq. (1.) Page 2
108 SITE INFORMATION AND .LOCATION Site utilities: 1
' ' Catch basin or aryls drain 18.76
Job site address: _ I
l2lG- Si ., --C -_.
City /SlatafLIP: Q Dryweli, leach line, or trench drain 18.76
_lJ Footing drain (no�I linear fl.: ) Page 2
Suite/bldgJapL no.: Project name: (1J IN(AT Ciro c"--C 1 Manufactured home utilities 50.03
Cross street/directions to job site: LOQA y n LL V. Manholes !I ] 18.76
_Rain drain conne4or 18.76
Sanitary sewer (4 linear IL: _) Page 2
Storm sewer (no. #ncar fl.: _) Page 2
Water service (na l linear ft.: ,_) f Page 2
subdivision: UO0.`n1iN" r Y -�� 1 Lot no.:. Fixture or item: II
Tax map /parcel no.: Baclflo�v pteventix 31.27 31. 27
DESCRIPTION OF WORK : Backwater valve 12.51
Clothes washer II 25.02
Dishwasher 1 . 25.02
Drinking fountain! 25.02
Ejectors/sump 11 25.02
8 PROPERTY OWNER ❑ TENANT Expansion tank 11 ( 12.51
Name: P n ` i y- l Fixture/sewer cap! 25.02
�/ 1 1 Floor drain/floor siitk/hub 25.02
Address:
City/State/ZIP: Garbage disposal I 25.02
Hose bib , 1 25.02
Phone: ( ) I Fax: ( ) Ice maker 1 I 12.51
.l] APPLICANT ❑ CONTACT PERSON Interceptor /grease;t}ap 25.02
Business name: 11 1-I. Lcuryta,cest. f]2 Medical gas (va1t $ ) Page 2
P '1 12SI
Contact name: Pik+
� �, ?)1:::) mr
Roof drain {colierciat) 12.51
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Address: t (Y .,��. Sinldbasin/lavatoiyl 25.02
City/State/ZIP: r Qe.... C4 -1-101 Solar units (potabletwater) 62.54
Phone: ( 1) 4 q.. 3ne, Fax:: (5{p 3i f 3 Tub/shower/showerpan 1151
E-mail: rata- hd,Scry.. s hoo . Urinal � 25.02
E -ma
CONTRACTO Water closet ; 25.02
water heater 1 1 37.52
Business name: s :ca ry Ct1.. ) 0-1061 Water
pipinglDWU 56.24
Address: Other. • 25.02
City/State/ZIP: I Subtotal F `
Phone: ( ) ' I Fax: ( ) j 1 Minimum permit fce: 572.50 i • 7 1 , ;-
t ! I 1 Plan review (25% of nermit to 1
1 CCB Lie.: 1 - 45 S 22'2_ Plumbing Lie. no.:
. State surcharge (12% of permit fee) y. -
Authorized signature: AL � It ^.^..... 1 TOTAL PERMIT FEE �, y(1
i Print name: a • • s ` ice e a.._ Date: This permit epplii anon expires ifs permit is not obtained within days
5 it has been accepted as complete.
'Fee methodoro set by Tri -Cmmty BuiLding Industry Service hoar
Moildin Terrnk !.1411 - PamitApp .dos 10!01109 410.4616T(11
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