Permit jj �
t � .1., i� it W, r f
v CI TY OF TIGARD 3 f 3 ri PLUMBING PERMIT
' ` - ° COMMUNITY DEVELOPMENT Permit #: PLM2013 -00045
T [GARD! 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/11/2013
Parcel: 1 S125DC09400
Jurisdiction: Tigard
Site address: 7284 SW SHADY PL
Project: Ash Creek Estates, Lot 27 Subdivision: ASH CREEK ESTATES Lot: 27
Project Description: (1) backflow preventer installation 3/6/13 REPRINT permit to correct description
Contractor: BURNESS LANDSCAPE Owner: WINDWOOD CONSTRUCTION INC
8630 SW SCHOLLS FERRY RD 12655 SW NORTH DAKOTA ST
BEAVERTON, OR 97008 TIGARD, OR 97223
PHONE: 503 - 572 -0009 PHONE:
FAX:
FEES •
Quantity Description Date Amount
•
1 ea Backflow Preventer 02/11/2013 $31.27
Specifics: 1 12% State Surcharge - 02/11/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 02/11/2013 $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: LLX..(.0 Permittee Signature: ,M l /1 /t G
I/ `1 P 4-1701
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.
IL CITY OF TIGARD PLUMBING PERMIT
j : COMMUNITY DEVELOPMENT Permit #: PLM2013 -00045
T f G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/11/2013
Parcel: 1 S125DC09400
Jurisdiction: Tigard
Site address: 7284 SW SHADY PL
Project: Ash Creek Estates, Lot 27 Subdivision: ASH CREEK ESTATES Lot: 27
Project Description: (1) backflow preventer installation Must maintain approved side /rear yard setback
Contractor: BURNESS LANDSCAPE Owner: WINDWOOD CONSTRUCTION INC
8630 SW SCHOLLS FERRY RD 12655 SW NORTH DAKOTA ST
BEAVERTON, OR 97008 TIGARD, OR 97223
PHONE: 503 - 572 -0009 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/11/2013 $31.27
Specifics: 1 12% State Surcharge - 02/11/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 02/11/2013 $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: , \ APPt4 ^ 1 f ( IL° 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.
FEB -07 -2013 03:53 PM I11 THOMAS.S.BURNESS
;IIlikunumukwi r. :cui;,i,.r• ,uu . 5034328525
Plumbic& remit A,p!kation .
Site Utilities - CEIv h l (Ill !'l l 11 l I ' 1. v.1 ••
City of and i. 0-1 =ill Permit No.: I= Ll ( 0013 d
- 13125 SW Blvd, Tigard OR ; 7 pl Bavlew
6 . Phone: 503.718.2439 Fax: 503. 2013 . : , Other Petm tNo.:
Inspection Lira: 503.639.4175 n ano Reedy/By: MI i1 S.e Pap 7 for
• I ' • • . ' Internet: www.tiglud- ar.gov CITY NodfiedlM.tbod;
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El New cortainction ❑ Demolition
For s erial iafanr�iow one ek�tgar:
❑ Addition /alteration/replacement ❑ Other: N Description
dwellings (includes 100 each utility concretion)
! 15 ;. '?' r 1w^ 1, 4 't, l' ,tt r ∎1 x J ft'G r2- df•. rJrt". ' • 4'3t1.:J ^" t .ys: SFR ( bath 312.70 •
li ^? ,. .:.1 ,.!'i !.!..,1 H'', .. , 1. ,:19 •,''t n;:. r :4 ,. ., •'N' .t. ., ..w JtE. r E ". : ::, ,a• , , . y !'.4',•":• 1.,1} - .
® I- and 2- family dwelling ❑ Co�mmarciel/indnslrial SRI/ (2) bath 437,79 •
❑ Accessory building ❑ Mule - family SFR (3) bath 500.32
Each additional batldkitehen 25.02
0 Master builder [] Other: Fire sprinkler (...,_._._ sq. ft.) Page 2 .
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Job side address: N. St,t� a� o a t s 14 t .. Catch basin or a rea drain _ _ 18.7
City/State/ZIP: f • Q Drywall, lemur line, or trench drain 18.7 w
- Footing drain (no. linear R.: _) Pegs 2 k ' l Suite/bldg. /apt. no.: Project name: / � C v - Manutbctured home utilities 50.03 -
Crose street/diroctions to job idle: _Manholes 18.76
N • Rain drain cenne'otor 18.76
• _ Simitery sewer (no, linear R_: ,_, Page 2
• .• - - Storm newer (no, linear R.: ) Page 2
Water service (no. linear ft.. _„_•) Page 2
n
Subdivision; 1-0 ib.: Fixture or Item! .
Tax map/meal no,: Backflow premier I 31.27
i ,t n / 1 t r . � a 1 , ,a r • Backwater valve 12.51
l
4 f 1 1 1 I r. ly /cT. r '/ 1 Il 11,r: . `v id -7, .. - -
w Lv�r „. 1 , r . f, sd u ti' n , nr . -: .•;, ; Clothes washer 25.02
Otna , Dishwasher 25.02
Drinking fountain 25.02
. •
Ejeotora/aump 25.02
x:, 1. y1 ' , hti 19 ` r .' . , p t..4 1, t o
t I ..1. R at:: :. • a . :a-ii ' „ :.'.:.4,1,":'::1, .,. :4 } L pi l „` ° c� .. f.. . . ` ; 't. 12
Expansion tank - _„_
Name: 1 �
Fixture/sewer cap �. 25.02
,,,-, IA) Co o w o a Door drain/floor sink/hub 25.02
Adt32esa: Garbage disposal � 25.02 T
City/State/ZIP: _ Hose bib _ 25.02
Phone: ( ) Y Flu: ( ) roe maker 12.51
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YF'� 1Y x + . 1 r (1 :'.. tY 'N' 1:1 h op r.., i r r t ■ L l sl L 1r ,, ,)ei 11 /g se trap 25.(]2
J.', i{'l ! •.. 1 d ., 1: la ,41 , t V'_,1,. . , . • �h .A. r 1.1" ',4,;,,,;...1,,,• . ,.k •�i,• ,4, , IV, • ... „,
S ttatae: Medical gas (value: S ) Page 2
'^'- Primer 12,51
Contriot name;
,. Roof drain (commercial) 12.51
Address: Sink/bamnnavatary T ._.__� 25.02
City /State/ZTP: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub/shower/shower pan 12.51
Bail: Urinal 25.02
T 4 „ ._ t r 4 { .„ �. • 11,;4„,,,, ' , s , ., 1 .' r r d .,, a; '••••••14 ' • { i ( s ' y water aloact . .. 25.02 �
i;.fi. t79 7 , ..;; , 1.1 ' .4 ( l „ "i ! ,, , r s : it �' i { t 'u r i l'n,,� 47 � "0 t` A'r, -,
Water heater 37.52
Business name: 1 i , _, . , a . / , r Water piping/DWV 56.29
Address: Sly 3a S Sc l-0 it s Pe.wy .... 4 - Other: 25.02 `
City/Stat r Subtotal
Phone: ( Sr)a - 000 7 r. Fax: ($7 )y3a. • $•Y 2.r Mioimum permit fee: 372.50
Lie.: / '" _ U (o Plumbing Lip. no.: ._._ Plan review (25% of permit fcc) 1
State surcharge (12% of permit fee) r�
Authorized signature: ___ TOTAL PERMIT FI EE p
1 ,1,. This permit spanoatton expires if a
tt been 1 is obtained within 18ry
0 d.
'Fee mathodutugy set by Tri.0 amty Bmldine Industry Service Board.
1 1 .doe 10101 /09 410.4616T(10/021COWWFB)
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