Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00334
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2013
Parcel: 1 S135DB04200
Jurisdiction: Tigard
Site address: 11270 SW 92ND AVE
Project: Killion Subdivision: DOGWOOD RIDGE Lot: 16
Project Description: Installation of solar hot water drainback system.
Contractor: NORTHWEST WATER WORKS Owner: KILLION,JACK T JR&
40110 SE MEADOW SONG RD BEVERLY
SANDY,OR 97055 11270 SW 92ND AVE
PORTLAND, OR 97223
PHONE: 503-314-1470 PHONE:
FAX: 503-668-0375
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/09/2013 $31.27
Specifics: 1 12%State Surcharge- 10/09/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 10/09/2013 $41.23
Plumbing
Class of Work: ALT
Type of Const: VB
Occupancy Grp: R-3
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 800 332.2344.
Issued By• Permi• i'e-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.
0 :I
Plumbing Permit Application
Site Utilities RECEIVED ,:,,,, (.H.,.,,.,:. , sr. ,,,.,.,.
City Of Tigard Received
Datc/B .;- 7?Aarff7110% I. ,ti Permit No.: 12,
IN. . 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
-: Phone: 503.718.2439 Fax: 5P08.192R15 1 r!''3 Dated3: -----77FlaSrair711121:11
Inspection Line: 503.639.4175
i
Is'kit!) Date Rearly/Ety: ! /uric 65 See Page 2 for
Internet: www.tigard-or.gov
CITYOF TIGARD Notified/Method; j So.plemental Information
TypPtalitaG DIVISION
Print name:MeRssa Newberii Date:9/20/13
CI New construction D Demolition
III Addition/alteration/replacement CI Other:;.-- ---'• FEE* SCHEDULE
For special information use checklist
CATEGORY OF CONSTRUCTION
Desert tion I Qty. I Ea. r Total
a 1-and 2-family dwelling LI Commercial/industrial New 1-2-family dwellings(includes 100 ft.for each utility connection)
,
SFR(1)bath 312.70
0 Accessory building 0 Multi-family
SFR(2)bath L_-, 437.78
0 Master builder 0 Other; 1 ,--, 500.32
c&-R(1)bath i
JOB SITE INFORMATION AND LOCATION ;-, ---■
Each additional bath/kitchen ;__,- 25.02
Job site address:I1270_SW 92ND Ave - Fire sp rudder(:, -;-.;;-..;sq.ft)
, Page 2
City/State/ZIP:'Tigard,OR 97223 Site utilities:
Caul btsin or area drain ; ; 18.76
Suite/bldgJapt.no.: I Project name:Killion Residence 1=•-•,
Drrn-il,leach line,or trench drain ;" 18.76
Cross street/directions to job site: ___ ; Footing drain(no.linear ft.: ') ___ Page 2
SW Greenburg Rd&SW 92rid Ave Manufactured home utilities
50.03
18.76
:
Manholes ---'i
-- - Rain drain connector 18.76
Sanitary sewer(no.linear ft:L ) Page 2
____
Subdivision:- -I Lot no.:- L
stnr," ewer(no.linear ft.:-___,) ; Page 2 ,- J
•
Tax map/parcel no.:R2759S4 Water'ervice(no.linear il.:,„,_;_) _ ..
Page 2 - '',
DESCRIPTION OF WORK Fixture or item: ).
;1', 31.27 51.fl
Install of a solar hot water drainbachy_st Backtlow preventer
goi
-Backwater valve ■ 12.51
CInthes washer ' 25.02 -'
'k :•.j
r
Dishwasher • 25.02
't
IR PROPERTY OWNER 0 TENANT Drinking fountain --;' 25.02
, .
Name:Beverly&Jack ICillion Ejectors/sump ': 2502
Address:11270 SW 92nd Ave Expan.ion tank 12.51
._
TiAturdsewer cap 25.02 j
_
City/State/ZIP:Portland,OR 97223 ,
_Eloos_crain/floor sink/h _ ,ub 25.02
Phone:(S03)968-2307 Fax:(;1 7 Garbs&e disposal ■---; 25.02 rl- 7-,
• •
0 APPLICANT Ei CONTACT PERSON Hose bib --; 25.02 , 1
•_„
,
Business name:One Energi Ice marter 12.51 , ---1
Interceptor/grease trap 25.02
Contact name:Megan Thomsen
Medical gas(vatue:S,__,,,,,,) _, Page 2
Address:10260 SW greenburg Ftd#400,
Primer - 12 51
.
City/State/ZIP:Fortland,_OH 97223
_ Roof drain(commercial) 12.51
..__,
Phone:(602)889-8619, I Fax::(602)437-471.0 Sink/hasin/lavatory ---i 25.02
E-mail:megan.thomsew@keoneetimy.cooi Solar units(potable water) 62.54
LI--
CONTRACTOR Tub/shower/shower pan ,_ ;' 12.51 .J
25
;7] .
-
Business name:Northwest Water W 1111iffir
orks 25.02
,
Water loset : 25.02
Address:40110 SE Meadow Son.2.120
Water heater 1 37.52 .
:- ----.
City/State/ZIP:Sandy,OR 9105$ . Water piping/DWV 7'
L
- 56.29
Phone:(503)314-1470 Fax (503)668-037 Other_ ;_I 25.02
CCB Lic.:113197 41/1/0k Plumbing Lic.no.: -333P0 Subtotal
-J.--'
Autho-' e, si.. - : 114 Minimum permit fee: $72.50 7,1,.5t.
/ / g
Plan review (25%of pemit fee)
IABuildin51Permita VIMU-PermitApactoe 10/01/09 440-4616T(10/02/COM/WEB) att. : 1'70