Permit CITY OF TIGARD PLUMBING PERMIT
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ti , COMMUNITY DEVELOPMENT Permit #: PLM2013 -00197
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 06/24/2013
Parcel: 2S 111 AB08900
Jurisdiction: Tigard
Site address: 9395 SW VIEW TER
Project: Jordan Subdivision: PENROSE TERRACE Lot: 34
Project Description: Install residential backflow preventer for irrigation
Contractor: PROGRASS INC. Owner: JORDAN, JO A
29895 SW KINSMAN RD 9395 SW VIEW TERR
WILSONVILLE, OR 97070 TIGARD, OR 97224
PHONE: 503 - 682 -6076 PHONE: 503-639-8171
FAX: 503 - 682 -9876
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/24/2013 $31.27
Specifics: 1 12% State Surcharge - 06/24/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 06/24/2013 $41.23
Class of Work: OTR
Plumbing
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 Spe • 'ode. and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is of sta : • thin 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to fol •w e rules • •pt: • by the Oregon
Utddy • enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 Yo ' may ob - - copy of the rules
or di . - ct questions to • . C by : • 503.232 1987 or 1.800.332.2344.
Iss ed By: I /�0 / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio • ate.
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.
Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
City of Tigard Received /_ / � / : � PermitNo � � H !3 _ a ,�q
Date /By. C�J
I 0 q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone 503 718.2439 Fax 503 598 1960 Date /By Other Permit No .
Inspection Line: 503.639.4175 Date Read /B tors See Page 2 for
T LC. A K D Internet www tigard- or.gov Notified /Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437 78
building SFR (3) bath 500 32
❑ Accessory g ❑ 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: 9395 SW View Terrace Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18 76
City/State /ZIP: Tigard OR. 97224
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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.: Fixture or item: t
Tax map /parcel no.: Backflow preventer 1 31.27
' DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Backflow Device Installation
Dishwasher 25 02
Dnnking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Jo Jordan Fixture /sewer cap 25 02
Floor drain /floor sink/hub 25.02
Address: 9395 SW View Terrace
Garbage disposal 25 02
City/State /ZIP: Tigard OR. 97224 Hose bib 25.02
Phone: (503) 639 -8171 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: ProGrass Inc. Medical gas (value: S ) Page 2
Primer 12.51
Contact name: Ken Christopherson
Roof drain (commercial) 12.51
Address: 29895 SW Kinsman Rd. Sink/basin/lavatory 25.02
City/State /ZIP: Wilsonville OR. 97070 Solar units (potable water) 62.54
Phone: (503) 682 -6076 Fax: : (503) 682 -4975 Tub /shower /shower pan 12 51
E -mail: Urinal 25 02
• Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: ProGrass Inc. Water piping/DWV 56 29
Address: 29895 SW Kinsman Rd. Other 25 02
City/State /ZIP: Wilsonville 0 . 9 170 Subtotal
Phone: (503) 682 -6076 ' ax: (503) 682 -4975 Minimum permit fee: 572.50 72.50
CCB Lic.: 8079 5r3 i Plumbing Lic. no.: Plan review (25% of permit fee)
-// State surcharge (12% of permit fee) 8 70
Authorized si TOTAL PERMIT FEE 81 20
Print name: Ken Chi
' top!' rson /_! Date: 6 - - 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.
I \Building \Permits \PLMU- PermiApp doe 10 /01/09 440- 4616T( I 0 /02 /COM /WEB)