Permit - CITY OF TIGARD PLUMBING PERMIT
111 - COMMUNITY DEVELOPMENT Permit #: PLM2011 00280
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2011
Parcel: 2S112BB08900
Jurisdiction: Tigard
Site address: 14265 SW FANNO CREEK LP
Project: YRIGOYEN Subdivision: COLONY CREEK ESTATES NO.3 Lot: 71
Project Description: Backflow for irrigation.
Contractor: OWNER Owner: YRIGOYEN, GREGG N & SHARON M
14265 SW FANNO CREEK LOOP
TIGARD, OR 97223
PHONE:
PHONE: 503 - 830 -3764
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/06/2011 $31.27
Specifics: 1 12% State Surcharge - 09/06/2011 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 09/06/2011 $41.23
Type of Use: SF Plumbing
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 -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: / ■mittee Signature:
Call 503.639.4 - . 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 Application
Site Utilities eR � ° FOR OFFICE USE ONLY
� ti Cl g Of Tl and " i REew ived
- D Permit No.: /J ! � n 131SW HaBlvd., Tigard, OR 7223n r0\ ' -mar APT C) / / '"U( Cj
Phone: 503.718.2439 Fax: 503.598.190 Date/By: Other Permit No.:
Inspection Line: 503
TIGARD. - �% o Date Ready /By: Juris: 21 See Page 2 for
J
Internet: www.tigard- or.gov .. I�
1k < I ,a 1�1. < ` 'Tr
_ Supplemental
,,;, ,,, . _- k . r -t-- :. *-._' „ -- s ; « ` - .: . A Information
•L :::„',
,,. , .,-r, ,re , $ € &,�c „aYsET�,< 4 g , :�= .. � ` _., n >, / „emu, :,r vt, #z�z � f
^
a -- 1�4:. _SCIlE1)LIA:t�, �` ,�- -.. rym 7
.. . <�::'�',.. %'�,,,,, ^.. a . -d5 - �^ ; :a`N.ir:: � ._, � :.i : i� ` , ? - � v w n.�. : '�
❑ New construction ❑ 1 5.gmglition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
°- GATECO- Q F:-iCONYST R LI ICON, V4Ar-:;:fil S FR ( 1 ) b 312.70
® 1- and 2-family dwelling SFR (2) bath 437.78
y g ❑Commercial /industrial
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
i�_ r 1N O 411ON =:AND:; r- O:
<, ^�' >;; �:.` $ � 1
.._ .,,�IuJO -- �STI?E €`' ,;:;.:> ^:- L ATIO. '' .';!; ,._ „ °,v Site utilities:
Job site address: 14265 SW Fanno Creek Loop Catch basin or area drain 18.76
City /State /ZIP: 97224
Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _ ) Page 2
Suite /bldg. /apt. no.: N/A I Project name: Irragation Manufactured home utilities 50.03
Cross street/directions to job site: Bonita and Hall 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: Colony Creek I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 1 31.27 31.27
12.51
Clothes was er 25.02
Adding three zone sprinkler system Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® mROPE1( O R Expansion tank 12.51
>, :... : .,, - ..- ,,. „_ , :..:: <; :. - „ter
Sp : �r �ly a�vT �- P
Name: Gregg Yrigoyen Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: 14265 SW Fanno Creek Loop
Garbage disposal 25.02
City/State /ZIP: 972524
Hose bib 25.02
Phone: (503)830 - 3764 Fax: ( ) Ice maker 12.51
® :'Af LCANT. Interceptor/grease
,... >.., - ••,._-- �,.,. :.. � : <- : ..' � A °P
<__ N1'; �RSQN� •, .,, trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Gregg Yrigoyen
Roof drain (commercial) 12.51
Address: 14265 SW Fanno Creek Loopq Sink /basin/lavatory 25.02
City /State /ZIP: 97224 Solar units (potable water) 62.54
Phone: (503) 830 - 3764 Fax: : ( ) Tub /shower /shower pan 12.51
E - mail: gyrigoyen @pacseafood.com Urinal 25.02
', aaax -a= >; Water closet 25.02
y.
Ct5 , CT()R -
:v.: _-a -«» >:, : •if:<ii; : >- - , ' ,a: `,":,:.'E•zii :'F. . 3- 'if ^ 4 - \'M
>, -- .. ...: -" �`:,•. s . _, r;; ^,.; »,:.., Water heater 37.52
Business name: N/A div.NUi-- Water Pg/
i p m DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal 31.27
Phone: ( ) Fax ( ) Minimum permit fee: $72.50 72.50
Plan review (25% of permit fee) -
CCB Lie.: Plumbing Lic. no.:
State surcharge (12% of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
Print name: Gregg Yrigoyen Date' 9/6/2011 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
C\ Building \Permits\PLMU - PermitApp.doc 10/01/09 440- 4616T(10 /02 /COM/WEB)
y
,0i
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
r� , i2c6 6 YeeZ16;ot741(/
Print Name of Permit Applicant
�
9 7�4 7/i
i naturel bf Perm A nip Date
Permit #: I" ) 11 004 Va
t
( i CD 5 . (-3 f e WNO �k
Address:
Issued by: fry Date: 91(0 11
This Copy for Permit Offices