Permit CITY OF TIGARD PLUMBING PERMIT
* ' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00111
T f GA R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 1 S135CA10000
Jurisdiction: Tigard
Site address: 11400 SW 96TH AVE
Project: Solera, Lot 9 Subdivision: SOLERA Lot: 9
Project Description: Installation of residential backflow preventer for irrigation system.
Contractor: TRADEMARK LANDSCAPES INC Owner: SOLERA LLC
P. 0. BOX 2410 9200 SW NIMBUS AVE
OREGON CITY, OR 97006 BEAVERTON, OR 97008
PHONE: 503 - 631 -3893 PHONE:
FAX: 503 - 631 -4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/06/2011 $31.27
Specifics: 1 12% State Surcharge - 04/06/2011 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 04/06/2011 $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 questi• • • •UNC by calling 503.232.1987 or 1.800.332.2344.
Issued B : ` Permittee Signature: 4111b) __!... 1 4 / e =
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 Applicatio CE
Building Fixtures KK��
City of Tigard 7)R - f Received 4 if Permit No.: ago- -0 f!/
'is 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
II Phone: 503.718.2439 Fax: so3s8.q OF TIGA Other Permit No.:
DateBy
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: orris: H See Page 2 for
Internet: www.tigard- or.gov Bt1ILDIN DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ D emolition For special information use checklist.
❑ New construction Description I Qty. I Ea. I 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
I=1 1- (2) bath 437.78 1- and 2- family dwelling ❑ Commercial /industrial 500.32
SFR (3) bath
❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
11 ` ) I - Catch basin or area drain 18.76
Job site address:
Drywell, leach line, or trench drain 18.76
City/State/ZIP: A ° 6 - _
Y � � �Z Footing drain (no. linear ft.: Page 2
la
Suite/bldg. /apt. no.: Project name: .'L�i � Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
W W/ ' `, j' r /re • . Sanitary sewer (no. linear ft.: ) Page 2
' Storm sewer(no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I.ot no.: Fixture or item:
Backflow preventer I 31.27 3 /,1"7
Tax map /parcel no.:
Backwater valve 12.51
DESCRIPTION OF WORK 25.02
t Clothes washer
3 Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT ---� Fixture /sewer cap 25.02
Expansion tank 12.51
l' `� C-
Name: VC-1----M. • ■ `(1 25.02
( Floor drain/floor sirlk/
Address: Cs- I �Y_ J U Garbage disposal 25.02
City /State /ZIP: t , I. �• I �00� Hose bib 25.02
1 Phone: (56N 1 . Le • F ax: i 5 V - 4 .21/4.Q • Ol0 I ce m aker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: •
. �� Primer 12.51
Contact name: N..).-) �_ � 1 12.51
A pI Roof drain (commercial)
Address: . �,,� A - t I ' L Sink/basin/lavatory 25.02
City /State /ZIP: ii rl i i I Solar units (potable water) 62.54
Phone: �) C .- 1.---� Fax: : ( ) Tub /shower /shower pan 12.51
Urinal 25.02
E -mail: ' I I
1'� 0 I Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: leg+ . l a„Q� ec- Water piping/DWV 56.29
Address: rp _ _ Other: 25.02
City /State /ZIP: DP 9- Subtotal
Phone: (�7j 1 - 3 3 F ax : 3 1 � 1 1 Minimum permit fee: $72.50 _S" )
V 3 Plan review (25 /o of permit fee)
CCB Lic.: l 155-3 as Plumbing Lic. no.: 151- 1p State surcharge (12% of permit fee) ;
Authorized signature: Mg r ' I TOTAL PERMIT FEE i; ii
V This permit application expires if a permit is not obtained within 180 days
Print name: L Date: ` after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I: \ Building \Permits\PLMU- PennitApp.doe 10/01/09 440 -4616 (10 /02/COM/WEB)