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Permit
CITY OF TIGARD PLUMBING PERMIT 1 7 t ' COMMUNITY DEVELOPMENT Permit# PLM2011 -00315 Date Issued 10/25/2011 TIGARD 13125 SW Hall Blvd . Tigard OR 97223 503 718 2439 Parcel 2S104AD05400 Jurisdiction Tigard Site address 12826 SW SEVILLA AVE Project Walnut Crossing, lot 1 Subdivision WALNUT CROSSING Lot 1 Project Description Backflow for irrigation Contractor JOHN DARBY LANDSCAPE INC Owner PAHLISCH HOMES, INC 13867 SW BENCHVIEW TERRACE 63088 NE 18TH, STE 100 TIGARD, OR 97223 BEND, OR 97701 PHONE 503- 579 -5298 PHONE 541 - 385 -6762 FAX 503 - 524 -6613 FEES Quantity Description Date Amount 1 ea Backwater Valve 10/25/2011 $12 51 Specifics: 1 12% State Surcharge - 10/25/2011 $8 70 Plumbing Type of Use SF 60 ea Minimum Fee Adjustment - 10/25/2011 $59 99 Class of Work ALT Plumbing 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 ` Permittee Signature ` A `l s 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 Oct 20 11 04 01p Kimmie 503 -524 -6613 p 3 Plumbing Permit Application Building Fixtures \ ® FOR OFFICE USE ONLY City of Tigard � CI� �� Permit No N at 13125 SW Hall Blvd,'I rgard, OR 97 � 614 4) ii Ca 44 )i1.--(1) ?1r C Phone. 503.7182439 Fax: 503398.19606\ t^� ® 6 OtherPennit No TIG Inspection Line 5036394175 4IeO iDate Ready Bp run. ® See page2fmr Internet worm 6 © gard -or goy , 1v{�C'v) brotifi�/Metbnd I Svpplemenbllvfarm TYPE OF WORK 'k 0%'.›, yw+ u v' FEE` SCHEDULE New cotulruction [} Ueiwhho n For special rnfommnan use checklist Description I Qtv I Ea Total ❑ Additiodalterationireplacement 0 Other. New 1- 2- family dwellings (includes 100 R for each utdily connection) CATEGORY OF CONSTRUCTION SFR (1) bath 31270 1 -and 2- family dwelling D Commercial/industrial (2) 437.78 SFR (3) bath 50032 L] Accessory building 0 MulE- family Each additional bath/kitchen 25 02 0 Master builder 0 Other Fire sprinkler ( .59- ft) Page 2 I JOB SITE INFORMATION AND LOCATION She utilities; Job site address: 12Ra :1/4...) ri ( G .N 1 A lm Catch basin or aria dram .__18.76 _. n� j Drywell, leach line, or trench drain 1876 City/State/ZIP Spa I i ii tit . Nit 22 Footing drain (no linear ft ) Page 2 Suite/bldg /apt. no. Project name Maaufactmed hones utilities 5003 Cross street/direetions to job site N xsrl } I f Manholes 18 76 )) 1� Rain dram connecter 18.76 Sanitary sewer (no linear It. _) Page 2 Stonn sewer (no. linear ft : ) - Page2 n \ Water service (no. linear ft.: ) Page 2 Subdivision: , 11'']] )/ of lit R$ CI,igV '>i I Lot no.. Fixture or item: Tax map/parcel no.: �� 1" ' / "v �� 4�' 3127 DESCRIPTION OF WORK Backwater valve 12.51 �1 S1_ 1 r Clothes washer 25.02 /rte' r, I : — *}-1 I,1 [ j_._., s.ce,s� �. Dishwasher 25.02 - r !J Drinking fountain 25.02 EjeetotSsump 25.02 SI PROPERTY OWNER 1 0 TENANT Expansion 1251 Name: ( �g �i� 0.0 Fixture/sewer cap 25.02 Q. 'p11� Garbage drain/floor sink/hub 25.02 Address: ('; 3C � \_�' , �y'� � 1i f yv Crarbage disposal 25 -02 City/State(�ZIP: (J ' n{C ■ l / �'�, yf} _ /Vr Hex bib 25.02 Photim (11 I) lt Fitz ( ) Ice maim, _ 12.51 0 APPLICANT ! 0 CONTACT PERSON Intaceptor /grease trap 25.02 Business name: Medical gas (value S ) Page 2 Primer 12.51 Contact name: Roof dram (commercial) E251 Address: Sink/basin/lavatory 25.02 City /State/ZIP: Solar units (potable water) 6254 Phone ( ) Fact: : ( ) Tub /shows /shower part 1251 E-mail: Urinal 25 02 Water closet 25 02 CONTRACTOR Water heater 37.52 Busin v `F\ M ,lU I ` . t . Water pipmg/DWV 56.29 Address: 1 l ['y� k „' 1 4'' _1 Other 25 02 City/StateiLlr- Phone' ( t}/�pr _ D 9f � 7 Subtotal l3) 5- )'1 / t G . r I I ^ Minimum permit fee. $72 50 7L '� y Pax. ( ) , �"�`f' ' 5 ' 701 t Plan review (25% of permit fee) CCB Lie.: 0 Plumbing lice no.: State swchargc (12% ofpamrttee) y�'�V Authorized signature _ -�` —" TOTAL PERMIT FEE i'2t H _ This permit upp expires if a permits not obtained within days Print name: { � �-) � - � �0.0Ti I after a Las tarn uccepled as complete_ ..✓/ *Fee methodology set by Tn- County Bnildmg Industry Service Board I '&. uigsan INIU- rarotMpaoc iOOtto 4 /COM WEB)