Permit CITY OF TIGARD PLUMBING PERMIT
c f Permit #: PLM2009 -00261
s . --; COMMUNITY DEVELOPMENT
Date Issued: 09/24/2009
: TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135DD04400
Jurisdiction: Tigard
Site address: 11900 SW GREENBURG RD
Subdivision: Lot: 0
Project: Southwest Family Medical
Project Description: Install backflow for irrigation.
Owner: FEES
BC ASSOCIATES LLC Quantity Description Date Amount
1128 SW ENGLEWOOD DR
LAKE OSWEGO, OR 97034 1 ea Backflow Prevention - 09/24/2009 $46.40
COM
PHONE: 1 12% State Surcharge - 09/24/2009 $8.70
Plumbing
26 ea Minimum Fee Adjustment - 09/24/2009 $26.10
Contractor: Plumbing
LBD LANDSCAPING LLC
7220 SE ALDER ST
PORTLAND, OR 97215
PHONE: 503 - 631 -8755
FAX: 503 -631 -8735
Type of Use: COM
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: U Permittee Signature:
Ll it II O ' J_.n 0 O I \L ( 1 p
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.
,x• 13:37 FAX 5035981960 CITY OF TIGARD 21001
• RECEWED • • ,
Plumbing Permit Application . p Q FOR OFFICE USE ONLY -
S E r 2 009 Received
City of Tigard Date/13 . q PermitNo.: p hi t§ . ,
13125 SW Pall Blvd., Tigard. OR 97223 CITY 0. , ' i P1anReview Othei Permit No,:
Phone: 503.639.4171 Fax: .503.598.1960 /�, /rg: >' t !''•iz Da : .
24- Hour Inspection. Line: 503.639,4175 BUILDI ti • •- ' Date Ready/By: see a for
InteInternet: www.ci.tigard.or.us Notifies/Method: INI Supplcm tnl I tion
• TYPE OF WORD FEE* SC :t e tILE
❑ New construction Cl Demolition For ,ecial in ormarlon use checklist.
— Description • Ba. Total
cgt Addition/alteration/roplacement Q Outer: New 1- 2- family dwellings (includes 100 it for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1) 249.20
❑ 1 • and 2- family dwelling Af Commercial/industrial SFR (2) bath _ 350.00 . '
SFR (3) bath 399.00
❑ Accessory building 1=1 Multi- family -
— _ _ Each additional bath/kite. en 4 U
[] Master builder ❑ Other. • Fire sprinkler ( sq. ft.) Page 2
d013 SITE INFORMATION AND LOCATION _Site utilities •
- Job site address:: // f • - — ` • / Catch basing area drain i 16.60
Drywell, leach line, or trench drain 16.60
City /State/ZIP: n a- -4d O • • ' 7.2--2- • Footing drain (no. lm= ft. :" _ .) Page 2
Suite/bldg./apt no.: Project name: .lei-) /u,� �TJSIG/. 110.00
�� I J � / Manufac home utilities
Cross street/directions to job site: Gti eir — , . Manholes 16.60
' - Rain drain connector — 16.60
- - - - - — - - ._ .. - - -_ . . Sanitary sewer (no. linear `ft„ . ) Page 2
Siorm sewer - (nd: linear R: - --). • • . . Page 2
Water service (no. 'linear ft:: - • Page 2,
Subdivision:- - - - • -- • I Lot no.: - - - _
F iiture;or item
1 Tax map/parcel no.: _ •- Absorption.valve 16.60'
-- ' -- DESCRIPTION OF WORK - • -- • .. - r Eacktlow preventer . / .Page 2' . yl'50
�� �-� Backwater valve 16.60
be��a'r /� J� — ~
Clothes washer -- 16.60
— — Dishwasher 16.60
• Dunking fountain 16.60
❑ PROPERTY OWNER gz TENANT 16.60
Ejectors/sump
Name: > • w&IZ r/ — M /II Oih'3 /,/G91", /...1.--4.0 L Expansion tank . - 16.60
Address: /I - o l ) _ _. 4 , -I / . - , w Fixture/sewercap 16.60
City/State/ZIP: ay . yy3 v ,i, C17Yt:1 Floor drain/floor aink/hub 16.60
/ Garbage disposal 16.60
_
Phone: ( .5 - 1," ) 7Gt+'j"X77 Fax: ( ) — Bose b 16 bib
Oil APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Busizmss name: 1 f4 '/ L interceptor /grease trap
16.60
Contact na X04/ G % -' —
Medical gas (value: ) Rage 2
� - i
Address: . Primer 16.60
7y, J ,Gt., drain (commercial) 16,60
City /State/ZIP: /4),(71.,j--)„., v,<„,_ 4 7
v, 1 1 . { 16.60
Sink/basin/lavatory
Phone: ( 50 ) 3 _I,— Fax : ( 1l ) - . Tub/shower /shower pan - . 16.60
E -mail / J u Urinal„ 16.60
CONTRACTOR - ' • . , water closet -' . - _ • 16.60 ' _ _
.
,„....• -- — Water heater 16.60
• Business name:
M L - -.. __... • . Other - :,' . ' - - - • , - .. -
Address: subtotal y y, S t7 •
City /State/ZTP: Mtuimum permit fee: 572.50
• . Fax: ( ) Residential bacldlow minimum Permit fea: 536.25 —
Phone: ( ) Plan revi (25% of permit fee)
(� �+ Plumb' Lic. no.: C r
CCB Lit.: 9 v5 —7,2) 7 �' 1 �? l J� `l / gJ State s urch arge (8% permit fee) O ' 70
Authorized signal= r ...g. ` �� TOTAL PERMIT FEE (V, yn •
This expires if a permit is not obtained within
Print name: - L EaJNL Date; s penult days after it has been accepted as complete.
`Fee methodology set by Tri- County Building Industry Service Board.
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