Permit 1 111 1 v CITY OF TIGARD PLUMBING PERMIT
- 8 - COMMUNITY DEVELOPMENT Permit #: PLM2012 -00305
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
Parcel: 2S112BC14500
Jurisdiction: Tigard
Site address: 14540 SW 82ND AVE
Project: Pac Rim Partition, Lot 1 Subdivision: 2007 - 038 PARTITION PLAT Lot: 1
Project Description: (1) backflow preventer for New SF
Contractor: GRD OUTDOOR LIVING Owner: PAHLISCH HOMES INC
PO BOX 821569 63088 NE 18TH STREET SUITE 100
VANCOUVER, WA 98682 BEND, OR 97701
PHONE: 360- 727 -5975 PHONE: 541-385-6762
FAX: 360- 882 -8815
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/22/2012 $31.27
Specifics:, 1 12% State Surcharge - 10/22/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 10/22/2012 $41.23
Plumbing
Class of Work: NEW
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: C � r , - _ t Permittee Signature: v� 1 ti rr' (�r� „ ^ 11 P 6
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. (•t
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 19 2012 15:35 HP LRSERJET FAX 360 - 882 -8815 page 2
Plumbing Permit AonhicatiuECEtVED
Site Utilities 1.01.: 1 1l I I ( • 1 I .1 (r.1) Ruched
City of Tigard OCT 2 2 2012 R ro Ix permit N. . pUt sole - 0
III 13125 SW Hall Blvd., Tigard, OR 97 Piro Review
I Phone : . 503.71&2 439 Fax: 503.5984d0' _, `!_ 1 ""' ° ��B Q 5raO1a. - D &,s
1 �/y� OtberPermitNo
t • Inspection Line: 503.639.4175 DIVISION Ready/By: S '.: 61 See Pigs 2 for
Internet: www,tigard- or.gov Notified/Method: menu] lcf
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ew construction ❑ Demolition For special Won :tailors toe checklist
Description I Qty. I Ea. I Total
❑ Addition/alierati n/replacement ❑ Other: New 1- 2 -family dwellings (includes 100 ft. for each utility connection)
r P �, r r'�x rr. .,31,7, r aJv. r L lW L'A. 551:∎: ^ :1 llfy 4 , ;� .
.I.F� ., ix VAM.A1 ! ,It'< gf�(Ua8t 1, rirYr.111t,,'r r ,i l l SFR (1)bath 312.70
t17�3. !. utF�_ ,1..........,a't, r.,j..F�iul,t ,.. 1►. uG� ..ir+1...+.7..uUfluC;vil:lw^� �"•�: ! ]. ��i.
1- and 2- family dwelling ❑ Commercial/Industrial SFR (2) bath • 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2
cl �MM S4 .,.,- 1 -,,,,,,,, w ( i o n 1 Rt •z ny. S µ ;vii a 1 f .' '.�( r 1, ;; Ni Site utilities:
Job site address: \ L CJ L.l ( �.),.�
alt
Job Catch basin or area drain 18.76
City/State/ZIP: " 1 .), ‘ . ` ., v� Y�+ell, Leach line, or trench drain 18.76
Footing drain (no. linear IL: _) Page 2
Suite/bldg. /apt no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 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 8: _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: BttcAdlow preventer l 3127 -sk 2
a7 g � c�rr , ( >v r a y._ a a: *3t►i:1fAF 1 p1� 'P�,s� "sf` '���• Backwater valve 12.51
y� ti1l !))!l it3i�fi r ft. ti I r .( LI� c, ': .
+i.{ ! ^�. (S a,.r4:.,..,, �, !.i,cw..: e. .attar kr volt i.l3txifniwlWaokim + l�lC �'
� Clothes washer 25.02
) r ,�••S
\ C \ Dishwasher 25A2
Drinking fountain 25.02
Ejectors/sump 25.02
r I exit Y1 TI,,1ir1l td II S9 f'r r.• Y• . , ac lR 5;' Expansion tank 12.51 ,
PI a, ' . fat 77 I a v`1,"�° D
deli �`' ?I Sit t hn u.utnclvxL nlI . ... !L.i" r j }" N1Y.n� �...t..2 'i� i1.? ��r'•
Name: ` Fixture/sewer cap 25.02 alis 1 � \ 1 '' ILA, ' Floor drain/floor sink/hub 25.02
' 111; f� 4� ��� -- Garbage disposal 25.02
City/StateJZiP. x
�j p N n� Hose bib 25.02
»` ._ Phone. ) . .. Fax. ._ ) • i► ..i Ice maker 12.51
i • '1M IP 1' iii'4�� ?11
111 1 1 fl i . 1I '� ''
T'' 1 ', � :z.e;, y#r11 i' l �r' .' Interceptor / trap 25.02
7 grease 1 ri.: � 1 I ! r 11 1 -�} � I.T= 1 !
tt Ul . . :' 2 . ;
. �iJ! ,a:.a,.�e.a.s ��..axa..,,,r,, �etu Ih 19.lt>i.a,}r,.l�f �i>�Ja1cc ..n �s. : iti3 Y�.JY�
Business ram s ` Medical gas (value: $ ) Page 2
` , l r ' c Primer 12.51
Contact name: t_� 1i ]�!�
Roof drain (commercial) 1231
Address: ,wAl lly_ 1 , Itor Sink/basin/lavatory 25.02
City/S • i ` ill� Solar units (potable water) 62.54
Phone , , a -- - Mil G �, 1► : Tub/shower /sbowler pan 12.51
il; Urinal 25.02
m , vje 'E', iy Fli (3 lti j;.t,.: +. _ 1.1:: y9 r;t1 " m Water closet 25.02
r.. t*al�a� ...._a;;a; t..s.;r2: e .a3�r xu4'�s.cNra �:,1 7rt Water heater 37.52
Business name: , I .
� ,�M NirtiapipinWDWV 5629
Address: i r . + r "1 • ∎• Oth er 25.02
City/State/ZIP: ii t, dr±e Subtotal
Phone: 3P_d 'L a a-(
' ' ` ( , ax: ( ) Minimum permit fee: $7230
� e - 1.' Plan review (25°/. of permit fee)
CCB Lie.: I� 0 1 � Plumbing Lic. no.:
State surcharge (12% of permit fee)
Authorized signature: ' % - _ ,` �-�`� TOTAL PERMIT FEE /. a4) se
Print name: ., , t, _ _'♦ ' Date: S GA � This permit expires U • pea mir h
not o1 within 1� days
�� after h has been accepted am con
*fee methodology set by Tri•Connty Building Industry Service Board.
L• 1Bwlding\Permita1PL U-PumitApp.doo 10101/09 440.4616r(10102/COM/WBB)