Permit CITY OF TIGARD PLUMBING PERMIT
`11 a COMMUNITY DEVELOPMENT Permit#: PLM2014-00077
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/20/2014
TIGARD Parcel: 1S125 DC08000
Jurisdiction: Tigard
Site address: 7034 SW ASH CREEK CT
Project: Ash Creek Estates, Lot 13 Subdivision: ASH CREEK ESTATES Lot: 13
Project Description: Backflow for irrigation.
Contractor: BURNESS LANDSCAPE Owner: ASH CREEK PROPERTIES LLC
8630 SW SCHOLLS FERRY RD 12655 SW NORTH DAKOTA ST
BEAVERTON. OR 97008 TIGARD, OR 97223
PHONE' 503-572-0009 PHONE 503-780 4375
FAX 503-432-8525
FEES
Quantity Description Date Amount
ea Backflow Preventer 03/20/2014 531 27
Specifics: 1 12%State Surcharge- 03/20/2014 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 03/20/2014 $41 23
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total S81 20
Required Items and Reports(Conditions)
i
This permit is issued subject to the regulations contained in the •ard Municipal Code. State of OR Specialty Codes arid all other
applicable law All work will be done in accordance with approv-o 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 ma obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 7
Issued By- � Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available in-section 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.
•
.Plumt)ing Permit Application
Nuilding Fixtures rl �, CID FOR OFFICE USE ONLY
City of Tigard , ° -.1••�' Received
g DatdBy. / / q Permit Nu.. p S
• 13125 SW Hall Blvd.,Tigard,OR' 3 z1 ` �`t �L 77
11111 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 0 201 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: Awls: B P/ for
Y
I IGAKl) Internet: %NIA IA.ti and-or. ov -'.cam
S g Notified Method: -PC Supplemental Information
TYPE OF WORK FEE' SCHEDULE
�
°l'(ew construction 111 Demolition For special information use checklist.
Description I Qty. I Ea. ( 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
�"I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
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:
/.0
` I 3 A L. G� Catch basin or area drain 18.76
Job site address: ` C
City/State/ZIP: Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name: r C- , , Es. Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
S'►Al ii,tr3 y p I 6_tLQ Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page G 2
Water service(no.linear ft.:_) Page 2
Subdivision: CAr 4.(21 L c J Lot no.: t 2 Fixture or item:
Tax map/parcel no.: CCC���� Backflow preventer i 31.27 /1,�7
DESCRIPTION OF WORK Backwater valve 12.51
1 �� II Clothes washer 25.02
j r r t.ye.-4-.CA . h t a P7l�i Dishwasher 25.02
O Drinking fountain 25.02
Ejectors/sump 25.02
m PROPERTY OWNER ❑ TENANT Expansion tank 12.51
`` � � Fixture/sewer cap 25.02
Name: W 0,..Du.,u 0
-
Floor drain/floor sink/hub 25.02
Address: („...) Al ea Garbage disposal 25.02
City/State/ZlP: �C4rY Hose bib 25.02
Phone ( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name:
Primer 12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax ( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
r^
Water heater 37.52
Business name: v fin,, d '3 Sc r ' �l" Water piping/DWV 56.29
Address: `� D w c.r I '- d Other: 25.02
City/State/ZIP: Subtotal ''/ 2"F
Phone:(�3 ) ,K,-??. .00 O I Fax:( ) Minimum permit fee: $72.50 72,s0
Plan review (25%of permit fee)
CB Li �� Plumbing Lie.no.: State surcharge(12%of permit fee) 7.70
Authorizeze d signature: �_� TOTAL PERMIT FEE ?',M
Thiilication expires if a permit is not obtained within 180 days
Print name: ✓!'� t/y�,(�L Date: , / (� s permit app after it has been accepted as complete.
( r •Fee methodology set by Tri-County Building Industry Service Board.
I:Building,Permits'PI.MU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)