Permit CITY OF TIGARD PLUMBING PERMIT
Ill I: COMMUNITY DEVELOPMENT Permit#: PLM2013-00305
T[G A.R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/29/2013
Parcel: 2S112BD07200
Jurisdiction: Tigard
Site address: 14747 SW 79TH AVE
Project: Brittany Meadows,Lot 8 Subdivision: BRITTANY MEADOWS Lot: 8
Project Description: Backflow for irrigation.
Contractor: GREAT SCAPES INC Owner: BRITTANY MEADOWS LLC
12473 SE CENTRAL PARK CT 16615 MAPLE CIRCLE
PORTLAND,OR 97086 LAKE OSWEGO, OR 97034
PHONE: 503-784-3869 PHONE: 503-781-1981
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/29/2013 $31.27
Specifics: 41 ea Minimum Fee Adjustment- 08/29/2013 $41.23
Plumbing
Type of Use: SF 1 12%State Surcharge- 08/29/2013 $8.70
Plumbing
Class of Work: ALT
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.
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Issued By: Permittee Signature:
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.
Plumbing Permit Application AccISI, iI. I Buiidin Fixtures rr11t tII 11r r, 1 4 t)`�1.\
g City of'Tigard `1,% p�a ��2zt '3 fit Permit No.: //pi I S
71 II 13125 SW Hall Blvd..Tigard,ot} "'4 $ Q�0 t Plan Wow Other Permit No:
■ ' Phone: 503.718.2439 Fax: 50. 598.l \G�` ��DiIic/ y:
Inspection Line: 503.639.4175 6� S Duty Ready/By: kris: See Page 2 for
I t t;��I I' Internet: www.tigard-or.gov �\� \ Notified/Method: j-T�( Sunmementnl Information _
TYPE OF WORK C 4 •1 FEE" SCHEDULE
l El
For spedal information use ecklLc'e
New construction [] i'aa chDescription t 3ty, I Ea. I Total
0 Addition/alteration/replacement ❑Other; it New 1-2-family dwellings(Includes 100 R.for each utility connection)
CATEGORY OP CONSTRUCTION i !I SFR(1)bath 312.70
SFR(2)bath 437.78
�1-and 2-family dwelling ❑Commercial/industrial SFR(3)bath 500.32
❑Accessary building ❑Multi-family I Each additional bath/kitchen 25.02
❑Master builder ❑Other: _ -Fuc sprinkler(_sq.lt) Page 2
JOD SITE INFORMATION AND LOCATION :s Site utilities:
Catch basin or area drain 18.76
lob Site address: 1Il(''1 5110 ;i I I 1)rywell,leach line,or trench drain 18.76
• City/State/ZIP; ' I .t 1.. v i - 1' ' Footing drain(no.linear ft.: J Page 2
Suite/bldg./apt. ta
no.: Project name; '�g 1- 16 Manufactured home utilities 50.03
Cross street/directions to job site: ' II Manholes 18.76
J Rain drain connector 18.76
Sanitary sewer(no.linear 4.:_) Page 2
Storm sewer(no.linear ft: J Page 2
I
Water service(no.linear ft.: L Page 2
Subdivision: ,,l'Ar` 11 • s Lotno.: uo Fixture oritem: n
Bnekllow pm/enter y., 3127 .5( l
Tnxmap/parcel no.: ��
EE Backwater valve 12.51
DESCRIPTION OF WORK IA �I Clothes washer 25.02
'1.. '
. / Dishwasher I 25.02
• Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT ;• --. .Expansion tank 12.51
Fixture/sewer cap 25.02
Name: 1 25.02
Floor drain/flour sink/hub
Address: I Garbage disposal 25.02
1 City/State/ZIP: Hose bib 25.02 .
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT } ❑ CONTACT PERS01y: Interceptor/Breese trap - 25.02
`' Business name: _ 1I Medical gns•(value:S=1 PBS
' Primer 12.51
•�, Contact name:
Roof drain(commercial) 12.51
Address: . Sink/basin/lavatory 25.02
....17 City/Stale/ZIP: Solar units(potable water) 62.54
I Fax::( )
Tub/shower/shower pan 12.51
Phone:( ) l
Urinal 25.02
_ E-mail: Water closet 25.02
CONTRACTOR •r
111 Water heater 37.52
Business name: A I i t I
Water piping/DWV F�
in WV S6.29
i Address: (, . t f-N j j. ._- 124'
; tr Other 25.02
ICity/State/ZIP: l , s miry _ I Subtotal
li Phone: LIMO. Fes;( ) Minimum permit fee: $72.50 �, �
( + ) - Plan review (25%of permit fcc)
\ w ii����/� Plumbing Lic.no.: State surcharge(12%of permit fee) y 70
Authorized signature: 117.0 TOTAL PERMIT FEE g .a0
Print name: 0 ' Date:i/. V�1/'. Tbis permit application expires If a permit is not obtained within 180 days
j�e • �� J II L�/M alter It lies been accepted as rnm te-
•Faa methodology set by Tri-County Building Industry Service Board.
I:\sullding\Pmmlte\PLMU-nertnnagp.Joe toNImo 440-4dtST(IonioicOMJWE13)
10/t0 'd 'ON XdJ WV 60:80 3f11, £t0Z-E0-d3S
_,_t' •
71 CITY OF TIGARD RECEIPT
2 ., 13125 SW Hall Blvd..Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 192893 - 08/29/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2013-00305 12%State Surcharge-Plumbing 100-0000-24001 $8.70
Total: $8.70
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 06394G BTAGGART 08/29/2013 $8.70
Payor: Michael Petersen/Great Scapes
Total Payments: $8.70
Balance Due: $0.00
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