Permit CITY OF TIGARD PLUMBING PERMIT
N
n,, COMMUNITY DEVELOPMENT Permit #: PLM2009 -00136
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 1 S133DCO3600
Jurisdiction: Tigard
Site address: 13170 SW FALCON RISE DR
Subdivision: Lot: 0
Project: Malone
Project Description: Install irrigation backflow.
Owner: FEES
MALONE, GREGORY & JOY Quantity Description Date Amount
13170 SW FALCON RISE DR
TIGARD, OR 97223 1 ea Backflow Prevention - RES 06/04/2009 $27.55
PHONE: 1 12% State Surcharge - 06/04/2009 $4.35
Plumbing
9 ea Minimum Fee Adjustment - 06/04/2009 $8.70
Contractor: Plumbing
MONAGHAN'S LANDSCAPE
4285 SW PARKVIEW AVE
PORTLAND, OR 97225
PHONE: 503 - 499 -1173
FAX: 503- 209 -4649
Type of Use: SF
Class of Work: ADU Type of Const:
Occupancy Grp:
Stories:
•
Total $40.60
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, o 's suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit otification Center • - - les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or rect questions to OU ■ • by ca in .03.246.6699 or 1.800.332.2344.
I ued By: / I .1 Permittee Signatur• ■
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.
Plurnbin Permit A lication
Building Fixtures RE CEIVED
City of Tigard Received � ,�+
JUN 012009 Uatc/i3v: 44. Permit ?l'ATP.'��
,,. • 13125 SW I fall Blvd., Tigard, OR 97223 Plan Review
Rew
5 • Phone: 503,639.4171 Fax: 503.598 1960 a Rev Other Permit No..
Inspection Line: 503 639.4175 � OFTIGARD
1 11, A R IT CIT 1 a+c Rcady — I Cif See Page 2 for
Internet: www.tigard�Lgov UILDIN DIVISIO O o + ;find Me +had. (5 Supplemental Information
TYPE OF WO FEE:" SCHEDULE
❑ New constriction Q Demolition Fors ecialit ormarion use checklisit
Description Qty. L a, Total
❑ Addition/alteration /replacement ❑ Other: New I. 2-family dwellings (includes 100 II. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath ^" ' 350.0(1
❑ Accessory building ❑ Multi - family SFR (3) bath 199.00
❑ Master builder ❑ Other:
" Each additional bath/kitchen 45.00
Fire sprinkler (_ sq. It) Page 2
JOB SITF; INFORMATION AND LOCATION Site utilities
-T r, --
Job site address: (517.0 4 ? & 3 -I ' / e 3(/' / Is . Dr. ('etch basin or area drain 16.60
City /Slate /ZIP: +I9Q rti 0 o4' 9 7, Drywall. leach line. or trench drain 16.60
Suite /bldg. /apt. no.: Project name: Fooling drain (nn. linear ft.: _ ) Page 2
Cross street /duet ions to job site: LL II Manufactured home utilities 1 10.00
1 11C� Y f ' - t I I J J R. - - Manholes 16.60
Rain drain connector 16.60
_ Sanitary sewer (no. linear it.: ) Page 2
�� Storm sewer (no. linear ft.: ) Page 2
Subdivision: " Water service (no linear It ) Page 2
Lot no.:
__ Fixture or item ^�
Tax map /parcel no.:
Absorption valve 16.60
- W DESCRIPTION OF WORK „ Baektluw preventer I Page 2 )
-• • ■ Pe S i 4'10 --L Backwater valve 16.60
•
Clothes washer 16.61
0)U C-- K, - - I Q 1)C L t (LI--
Dishwasher 16.6)
❑ PROPERTY OWNER El TENANT
thinking tnuntain 16.60
" - Ejectors /sump I 6.6(1
Name: ( (' e c. -+ .Arsu. riles Lei- -t s Expansion tank 16.60
Address: l , .5 7 (1 c;Li A-c . I c u r 1 f2 t S t ' r Fixture /sewer cap e 16.60
City /State /ZIP; Lt. v c' Floor drain /floor sink/huh 16.60
Phone: ( ) Fax: ( ) Uarhagc disposal 16.60
APPLICANT Bose hih 16.60
❑ ❑ CONTACT PERSON
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
Sink/basin/Iavatury 16.60
Phone: ( ) Fax:: ( ) _,_ •.._._
°'- - Tub/shower/shower pan 16.60
E-mail:
_ Urinal 16.60
CONTRACTOR . Water closet 16.60
_ __
Business name: ..0 L C l' �C i n S C ! r�
Water heater 16.60
S
Address: i a �� `YW
a�,LRry�tL At w. Other.
5_ Subtotal
City /State/LIP:
pc, rtlUy (,f' s r
i . _ —.-.. •• -..- -^-- Minimum permit fee: $72.511
Phone: (50:5 ) 4c..ti ci - 1 1 .i _ W F ax x :l , ., : _ q,,,,c�1 Residential haekflow minimumye�it fee: $36.25 1 (0 . -
4-30- I 6 � Plumbing Lie. no : Plan review (25% ot'permit fee)
State surcharge (12% of permit tee)
Authorized signature: TOTAL PERMIT FEE C/0, f
,
Print name: 3 •v-`c-'_s tail S: Yl <1 C Y' 1 Date: 6,1 (X JCJ This permit application expiret if a permit is not obtained within
180 days after it has been accepted as complete.
•Fee rr !tluutnlnpv :et by Tri.Cnuniv Rnildin Indnstry Service Roan)
Z/Z d cc
6ZZ1 LO-90 -6002