Permit CITY OF TIGARD PLUMBING PERMIT
tx COMMUNITY DEVELOPMENT Permit #: PLM2009 -00185
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/13/2009
• Parcel: 2S103CC00800
Jurisdiction: Tigard
Site address: 12055 SW ROSE VISTA DR
Subdivision: Lot: 0
Project: McPherson
Project Description: Install a backflow device
•
Owner: FEES
MCPHERSON, LORIN Quantity Description Date Amount
12055 SW ROSE VISTA DR
TIGARD, OR 97223 1 ea Backflow Prevention - RES 07/13/2009 $27.55
1 12% State Surcharge - 07/13/2009 $4.35
PHONE: Plumbing
9 ea Minimum Fee Adjustment - 07/13/2009 $8.70
Plumbing
Contractor:
BEAVERTON PLUMBING INC
13980 SW TV HWY
BEAVERTON, OR 97005
PHONE: 503 -643 -7619
FAX: 503 - 643 -7620
Type of Use: SF
Class of Work: ALT 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, 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: ibl4Aiat lam Permittee Signature: n n 2CteeL
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.
07/10/2009 11:02am #232 Page 01/03
Plumbing Permit ApQlieati 1 R ECEIVED n
Site Utilities F OR OFFICE 11SE ONLY •
City Of Tigard R �ee,ved Permit Nn.: x1 - 0vit7
I>ae/By
a 13125 SW Hall Illvd., Tigard, OR 9727 -�UL 1 2009 P 4u, Reviaw
C other pennil No..
I Ph one: 503.634.4171 Far: 503.5'18.1960 Dat c/By:
Inspection Line: 503.639.4175 CITY OF TIGARD Doti' ttr,dy /By: twig; SS See Page 2 far
t ' 1 C.ARD Notified/Method: o lementnitnformation
Internet: www.tigaM- or.guv
P - ' 111 I . •.:�. .. x : +g . .
1 � {� JJ� l t. S. D t ; is >:p:,;:. :FEF . ; SGHEDtI; :` i:; *:;:.
❑ Detuolition 1 7.- . 1%orspecial infam:arion Use clurkli L
❑ Nutiv COnstmeLlOn Description 1 Qty. 1 Ea. ) Total
El Addition /alteraliou/replaccment ❑ Other: I Ncw 1- 2- family dwellings (includes 100 ft. for each utility connection)
•••:..:-.,•:''',-,:;.: • , 249.10
Y.K' CAWEG.OR' OI OPIR11U.0 ' ON _�; :. SFR (I) bath
El :, ;:.:., ;:.`:= - • :.. : :.._... ..: ' 350.00 • .
Conmrcrcial /industriul SFR (2) bath
I. and 2- family dwelling ❑
I SFR (3) bath 399.00
❑ Accessory building ❑ Multi-family 45 0U
Each additional bath/kitchen
❑ Master builder ❑ fir. I Fir: sprinkler sq. ft.) Page 2
_ '>:. ;t ;JOB SITEhINFORMA'ilOf `ANiI LOCATIONr Sltc utilities
Job site address: 12055 SW Roscvistn Dr I Catch basin or area drain 16.60
Drywell, leach line, or trench drain 16.60
City /StatelZ�: Tigard, Oregon 97223 I
suite/bldg./apt. no.: Project name: McPherson i Footing drain (no. linear ft.: pare 2 I Manufactured home uttlitics 110.00
Cross street/directions to job site: I Manholes 16.60
I Rain drain connector 16.60
Sanitary hewer (no, linear ft.: _) Page 2
I Stnnn sewer (nu. linear ft.: Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: 1 it TO
I Fixture or item
I' mty,/parcn l no.: Absorption valve 16.60
- , gi
: :` ... . . Rll''1'LOP[v0 W4RKst . s j _ . Bnck(luw preventcr I Page 2 •
Install a Backllow device I Y.. Backwater valve 16.60
I Clothes washer IG.60
Dishwasher 10,60
.r: .- ' :. :3 .,''� .. T :'• sx''. a "CENA • T', ' i :i,- un
Drinking fountain 16 60
® •.PROP O ,::a .: =.;, `. sa ... - .. E j ectors/sump 16.60
Nanic: McPherson I Expansion tank 16.60
Address: 12055 SW Rosevista Dr I Fixture/sewer cup 16,60
Floor drain/floor sink)bub 16.60
City/State/ZIP: Tigard, Oregon 97223 Garbage disposal 16.60
Phone: ( ) Fax: ( ) I 10,60
�, $;= Host bib
:1 - OPiI'A - • - • Ol; ;`∎' :
<f . ®APPLI • : : ` i`.: °' = r < _ 16.60 � ... Ice maker
Business name: Beaverton Plumbing, Inc 1 Interceptor /grease trap 16.60
Contact name: Sue Medical gas (value: $ !) - Page 2
Address: 13980 SW Tualatin Valley Hwy
Primer 16.60 -
Roof drain (commercial) 6
City /Stute/LIP Rcaverton, Oregon 971105 - 16 16.0 . 6 0
Sink/hasiMavawry
Phone: (503) 643.7619 I Fax:: (503) 643.7620 I 16.60
Tub /shower /shower pan
E -mail: Sue(ri beavertonplumhing.eom Urinal 16.60
.
.� °° ' : � . ":. .::j;CON TRACfOIi' : ;.3` . . .1_ '`�; . '`,� Water closet 16.60 •
. ,_ ,- . �:
Business name: Beaverton Plumping, Inc • Water heater 16.60
Address: 13980 SW Tualatin Valley Ilwy Other
• Subtotal
City /State/ZIP: Beaverton, Oregon 97005 I Minimum permit tee: $72.50 36.25
Phone: (503) 643.7619 Fax: (503) 643.7620 I Residential backflow minimum • rmit fee: $36.25
Plan review (25% of permit fee)
CCB Lic.: 12889 Plumbing Lic. no.: 34j4PB o 435
State surcharge (12 /a of permit fee)
Authorized signature: 41 ' TOTAL PERMIT FEE 435
Print name: Susan Dean Date: 7 /10/2009 I This permit application expires if a permit is not obtained within
t _ 180 days after it has been accepted as complete -
*Fee methodology set by Tri -Canty Building Industry Service Board.
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