Permit CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT (O,( Permit #: PLM2013 -00034
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/31/2013
Parcel: 2S104DC01900
Jurisdiction: Tigard
Site address: 13485 SW BENCHVIEW TER
Project: Orsay Subdivision: BENCHVIEW ESTATES Lot: 19
Project Description: (1) backflow preventer 3/6/13 REPRINT permit to correct description
Contractor: JOHN DARBY LANDSCAPE INC Owner: ORSAY, PAUL
PO BOX 231115 13485 SW BENCHVIEW TER
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 519 -7168 PHONE:
FAX: 503 - 524 -6613
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/31/2013 $31.27
Specifics: 1 12% State Surcharge - 01/31/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 01/31/2013 $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 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: j - Permittee Signature: D� 4PPo 0-i71 Uict
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 the project.
Approved plans are required on the job site at the time of each inspection.
n CITY OF TIGARD PLUMBING PERMIT
a' - COMMUNITY DEVELOPMENT Permit #: PLM2013 -00034
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/31/2013
Parcel: 2S 104 DC01900
Jurisdiction: Tigard
Site address: 13485 SW BENCHVIEW TER
Project: Orsay Subdivision: BENCHVIEW ESTATES Lot: 19
Project Description: (1) backflow preventer
Contractor: JOHN DARBY LANDSCAPE INC Owner: ORSAY, PAUL
PO BOX 231115 13485 SW BENCHVIEW TER
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 519 -7168 PHONE:
FAX: 503 - 524 -6613
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/31/2013 $31.27
Specifics: 1 12 %State Surcharge - 01/31/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 01/31/2013 $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 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: Permittee Signature: . I /I PP , n I /► % / U
• 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 the project.
Approved plans are required on the job site at the time of each inspection.
John Darby Landscape, Inc 503 - 524 -6613 p.2
Plumbing Permit Application
Building Fixtures RECEIVED
City of Tigard Recei ed
II
» 13125 SW Hall Blvd., Tigard, OR 97223 JAN 3 1 2 013 �r 1 31 / 3 Pernik No.: P( PO / 3, - 0093
Phone: 503.7182439 Fax: 503.598.1960 Ran Review
Inspection Line: 503.639.4175 CITYOFTIGARD Di': Other Pew "'°_:
T I G A R D Date Read
Internet ttrntivsigard -or.gov y /By: ' � ® See Page 2 for
BUILDING DIVISION Notified/method: � i Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
�Arldition/alteratiodreplacement Description I Qty. I Ea 1 Total
❑ Other: New 1- 2 -Ihml dwellings gs (includes /00 11 for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
g 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑Mu1ti- family _ SFR (3) bath 500.32 '
Each additional bath/kitchen 25.02
Fire sprinkler ( sq.1L) Page 2 I
❑ Master builder ❑Other. -
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Bs Sw 18.76
Ci I .n_ch u ► PI� eistile e
Catch basin or area drain
City /State/ZIP: t s� A. 0 r/ 9 7 3 Drywall, leach line, or trench drain 18.76
.!a no.: M~ - Footing drain (no. linear It: ) Page 2
Suitefbld
g pt Project name: j j t b' S m/
/ Manufactured home utilities 50.03
Cross street/directions to job site: �+ 1 M anholes
( � ‘-1,t_9.4.1 � � 1 �Ci � `� \�)' C j ZA7 18.76
`� >A_ir1 e 1 e r C e Cck- Al. - Rain drain connector 18.76
r C3 Nf` 1A P ;i a el C", -k4 k l..: f : k 9 p Sanitary sews (no. linear ft.: ) Page 2
V l °L�.1,.'� u.3,0 c71 G_! 't „t. Sto rrrt sewer (no, linear ft: ) Page 2
Water service (no_ linear 11:_____) Page 2
Subdivision
fl,e_M■ t : % A) l e t z F-,7tget,es I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
' DESCRIPTION OF WORK
Back valve 12.a I
. y ' 11 i . , i Clothes washer 25.02
` L... I '�_ Dishwasher
' 25.02
' Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 ;
Name: ��'\ 0� �- Facture/sewer cap 25.02
Address: = Floor drain/floor sink/hub ,
25.02
City/State/ZlP: � �.� q Garbage disposal 25.02 1
` 7 ��3 Hose bib 25.02
Phone: ( ) I Fax: ( ) • ice maker
12.51
A APPLICANT ❑ CONTACT PERSON interceptor/grease trap 25.02
Business name: "3 ky\ 0 4� {s v 1 q rt L _„ Medical gas (value: $ ) p 2
Contact name: 1R •�� " � e.
Amer 1251
Address: Q .. t �] a t �11 Roof drain (commercial) 12.51
Addre
City/State/ZIP: '^ l r Sink/basin/lavatory 25.02
1�-L�� 4`+] �� Solar units (potablewaler) 62.54
Phone: () r 1,9 _31 / Fax: : (Q -) 52-;1-4 � I aj Tub /shower /shower pan 1251
E- rnail : :L► \ O \ ' 1 ' t n il G i - • A b & � ' Urinal 25.02
CONTRACTOR
Water closet 25.02
Business name: l Water healer 37.52
k (45\Qy 1 ��k`� Q e waterpiping/DWV 56,29
Address: p tv F 9 r� 2. I 1 ( n'�
Other er:
!� l L 25.02
City/State/Z1P: i & r? q � a I Subtotal
Phone: (/ ' T 5/9_7 [ 0: Fax: ( ) g,9-#440/3 Minimum pcaroit fee: $72.50
CCB Lie. 71 G Llk, ki Plumbing Lic. no : Plan review (25 %ofpermit fee)
Authorized signature: ! s State surcharge (1 2% of permit fee)
I Print n111t1e TOTAL PERMIT FEE � _ .). D
)k,yl , � D al / =1 1 R f 3 1 Th perm application expires if a permit is not obtained within 180 days
( [ after it has been accepted as complete.
"Fee nlethodolog set by Tri -County Building Industry Service Board.
1-1Boad;.etnwokstouviz nc. App.da 10/0 1/09 141M61611lO 2fCOMhVE13)
John Darby Landscape, Inc 503 - 524 -6613 p.1
FAX COVER SHEET
FROM: John Darby Landscape, Inc,
503 -579 -5298 office
503- 519 -7168 cell
503 - 524 -6613 fax
TO: C5i a .D
RE: 7156CJ0 I V VIA
DATE: / '31 — /3 _
TOTAL PAGES(including cover sheet) 3
yfrD'O
•
13867 SW Benchview Terrace Tigard, OR 97223