Permit •
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.71 . CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00331
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/14/2012
Parcel: 2S 111 BCO5100
Jurisdiction: Tigard
Site address: 10233 SW MURDOCK ST
Project: Mitchell Partition; Lot 3 Subdivision: 2006 -044 PARTITION PLAT Lot: 3
Project Description: (1) backflow installation
Contractor: TERRA -SOL LANDSCAPING Owner. GERTZ CONSTRUCTION
21685 SW HEDGES DR 9200 SW 46TH
TUALATIN"
UALATIN", OR 97062 TUALATIN, OR 97062
PHONE: 503 -691 -6105 PHONE: 503-692-3390
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/14/2012 $31.27
Specifics: 1 12% State Surcharge - 11/14/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 11/14/2012 $41.23
Plumbing
Class of Work: OTR
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 MunicipaJC 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 ork is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires • o ..flow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 91- 001 -0090 ou may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. (/
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Issued By: Permittee Signature:
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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 e project _
Approved plans are required on the Job site at the time of each • .
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Plumbing Permit Application
Building Fixtures RECEIVED - FOR OFFICE' ONLY
City Ti and Received
7111 . u 131 SW Hall Blvd, Tigard, OR 9 � MI 14 2 �'■? Date/By: I I 1 i 4 113.- Sal Permit No.: PLa4 e vId . _ 170 33
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 A D� Date/By:
y: Other Permit No.: Kgr 0 1 -10(5//
T I G n R D Inspection Line: 503.639.4175 ornG Date Ready/By: kris: el See Page 2 for
Internet: www.tigard or.gov RM IDINGDNt Ready/By: Notitied/Method: Supplemental Information
TYPE OF FEE* SCHEDULE
> Alew construction ❑ Demolition For special information use dteck1j t
Description Qty. Ea. Total
❑ Addition /alteration/replacement ❑ Other: • New 1- 2- family dwellings (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
O A- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION • Site utilities:
Job site address: / 02.'6°7 A3 , Y , � 7 D Lf� Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: 71 (04.01.Q i
Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt. no.: I 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 ft.: ) Page 2
Subdivision: I Lot no.: Figtint -erv4t
Tax map /parcel no.: Backflow preventer) 31.27
DESCRIPTION OF WORK • water valve 12.51
v� � + Clothes washer 25.02
t4,(A -- c" ..1) z Q� L A 7 CO i Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
V PROPERTY OWNER /, '_ t I ❑ TENANT Expansion tank 12.51
V
Name: Q�'Z z. Oe �r Fixture /sewer cap I • 25.02
t
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) 1pl 2 - 9 23 t t0 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) . 62.54
Phone: ( ) Fax:: ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: I r Q j Q x ( M I Lj ' v4 k Water piping/DW V 56.29
Address: Q tP 1 _ ff Q'4 r< O ♦ Other: 25.02
City /State/ZIP: - 1, ( WIl I d rt 4? QC , Z- Subtotal
Phone: ) ‘9 1 - Fax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: ' 0 ( 9 A i],/is,//.Plumbing Lic. no.:
State surcharge (12% of permit fee)
Autho - - natur•: ( I TOTAL PERMIT FEE g
Print name \- ‘ i y\ ca K (2, yn,144L Date: /1/ !21i L This permit application expires if a permit is not obtained within 180 days
/ /// after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
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