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Permit
CITY OF TIGARD PLUMBING PERMIT - COMMUNITY DEVELOPMENT Permit#: PLM2013 00303 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2013 Parcel: 2S104DD07800 Jurisdiction: Tigard Site address: 12866 SW MORNINGSTAR DR Project: McCarthy Subdivision: MOUNTAIN HIGHLANDS NO.3 Lot: 36 Project Description: Installation of residential backflow preventer for irrigation Contractor: LJH LANDSCAPE& IRRIGATION Owner: MCCARTHY, JUSTIN C&MICHELE M 14210 SW KIMBERLY DR 12866 SW MORNINGSTAR DR BEAVERTON, OR 97008 TIGARD,OR 97223 PHONE: 971-285-1691 PHONE: 503-888 4377 FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 08/28/2013 $31.27 Specifics: 1 12%State Surcharge- 08/28/2013 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 08/28/2013 $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, • wo • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility 'otification Center. hose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or di--ct questions to OUNC by - • 503.232.1987 or 1.800.332.2344. Is ued By: / /t Permittee Signature: _ ' • 4empCall 503.639.4175 by 7:00 a.m.for the next available insp= 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 l ST ONLY City of Tigard Received omen Permit No.:PC-�//�/3-60 So III • 13125 SW HaII Blvd.,Tigard,OR 97223 Plan Re' ' = Plan Review Phone: 503.7182439 Fax: 503.598.1960 Date/By: Other Permit No.: TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Jarir H See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction ❑Demolition For speda/information use checklist. El Addition/alteration/replacement [fOther q - New 1-2-f Qty. Ea. Total r+ep LL.JRL.,��uL�ot�J New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 Dill-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 50032 ❑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: t Z6 Cole 50 1 o�k911J 55r4� D'Q.. Catch basin or area drain 18.76 'T111041) ok� Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear it: ) Page 2 Suite/bldgJapt.no.: I Project name: Manufactured home utilities 50.03 1 lav Cross street/directions to job site: Su) In-P..... 4,4it;... ' *Ifrik Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_J Page 2 Storm sewer(no.linear tt: ) Page 2 Water service(no.linear ft: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Badcflow preventer I. 3127 Zi..27 DESCRIPTION OF WORK Backwater valve 12,51 Clothes washer 25.02 I as i W T J � ,J Dishwasher 25.02 Clz Drinking fountain 25.02 /! Ejectors/sump 25.02 ® PROPERTY DOWNER I ❑ TENANT Expansion tank 12.51 Name: J u5T-I0 A OVIICJ►L�t;.Ll_E. N CC �.1 F�.�C Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Z iS Cdo S1_9 KAMA)10/isrpait. tDQ. Garbage disposal 25.02 City/State/ZIP:7' , yth j ©1 7 L 3 Hose bib 25.02 Phone:(503) 1,. 4 3-77 Fax:( ) Ice maker 12.51 Ii APPLICANT ❑ CONTACT `PERSON Interceptor/grease trap 25.02 Business name: L..S Is. Lcm,.%SL '�I��Q.t641101�7 Medical gas(value:$ ) Page 2 1 nn` q Primer 12.51 Contact name: L 1�`( Q J. \f3G3/....M4.40 Roof drain(commercial) 12.51 Address: I AZto GW ,F`..1(kaiiQ.L-L; .0 2_ . Sink/basin/avatory 25.02 City/State/ZIP: $ Nt ce..aADO/ o2_ 'Y)Cf51 O Solar units(potable water) 62.54 Phone:(9 71) Z,A CJ.tic q ( Fax::( ) Tub/shower/shower pan 12.51 E-mail: 1 a.r�ity @ 111'1\ei Nld►ct.a Z;Y(GQ∎.f f tgc3.k 1 cal.GD I1Vt Urinal 25.02 .J d water closet 25.02 CONTRACTOR '\ Water heater 37.52 Business name: L.N LA,D5e 4t. ifIci JGi_ oj Water piping/DW V 56.29 Address: 147.00 SJ ‘4,04201.1-ti Other 25.02 p City/State/ZIP: S J��4. E52_ . 7 P ) Subtotal 31.L7 Phone:(9?( )226 - J( ( Fax:( ) Minimum permit fee: $72.50x'12.50 �B Lie.: g 7 A 2% Plumbing Lic.no.: Plan review (25%of permit fee) .- State surcharge(12%of permit fee) 00 Authorized signal I =%: TOTAL PERMIT FEE`%womb J2. /,� A.,,, Print name: )) ,�,�� Date: This permit application expires if a permit is not obtained within 180 days 1w! �� t �^� after it has been accepted as complete. 'Fee methodology set by Tri-County Building Industry Service Board. IABuildingWerrnitsWLMU-PmmtApp.dm 10/01/09 440-4616T(10/02/COM/WEB)