Permit 1 � ,� CITY OF TIGARD PLUMBING PERMIT
11 s , COMMUNITY DEVELOPMENT Permit#: PLM2014-00088
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2014
Parcel: 25111 DC 13600
Jurisdiction: Tigard
Site address: 15865 SW OAK MEADOW LN
Project: Hilton Subdivision: SUMMERFIELD NO.11 Lot: 632
Project Description: Installation of residential backflow preventer for irrigation
Contractor: MP PLUMBING CO Owner: HILTON, HARRY M& DIANE M
PO BOX 393 15865 SW OAK MEADOW LN
CLACKAMAS, OR 97015 TIGARD,OR 97224
PHONE: 503-655-9161 PHONE
FAX: 503-655-1726
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/31/2014 $31.27
Specifics: 1 12%State Surcharge- 03/31/2014 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 03/31/2014 $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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notific. • -nter. 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•.-stions to O b C b calling 503.232.1987 or 1.800.332.2344. J�
Issued :y: /li I / Permittee Signature: ) r
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.
FROM MP Plumbing (MON)MAR 31 2014 10:08/ST. 10:08/No.8308284208 P 1
Plumbing Permit Application
Site Utilities 1 1 1 1! I l I I 14 1 1 ti . 4)\I 1 q, ,/ p�j
C1� Of Tigard Received •,2 2r I4 (-----k..)....0 PamihNu.: )LNalei4 ' c2 0 3
Dare/By, �J `7
II __ • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DatcBv, Other Perini(Nu.:
1 i � Inspection Line; 503.639.4175 Date Readyfty; Ju e: td See Page 2 for
Internet www.tigard-or,gov NotlfwrirMethod: SupplementalInformidoa
n1:'•:. 1 , 1 ',"-•".':'1' 1 Z i ) 1) 1 1 1 4t , ; '';'"1;'''',;; i
ll r� ff
1f))i 0;1..,r 1.11 Y(.1 Y1..,1.■r l '..,Irl 1,111 .r^':A'N 4t. 'cm:,,{ I.414.0A.,Iry.r lA.I4!I.rIvI.'4 ,r... r).11e),) ..r.,1.., 4 e.•1. .1...•.l1'A.. .lAr.+.I:..)yl ..'.1!.......r r r •. ..M{Y.Ir,..r•.M{,! ..1...1..1.•:-.,,;.:Vi:.:):;;;,:',.,./4,.':,,1: 11-1i,1.. .,;)
❑New construction ❑Demolition For"oda!Information use checklist
_ Description I Qty. I Ea. I Tutal
IS Addition/alteration/replacement ❑Other: New 1-2-faintly dwellings(includes 100 ft.for each utility euhwaaion)
;r7;;‘;,r.,;.';',.',, ' 1 r,1 1 1;,' + 1 '' SFR(I)bath 312.70•® I-and 2-family dwelling El Conunercial/industrial' SFR(2)bath 437.78
CI Accessory building CI Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ID Other: '
sprinkler( sq.11.) Page 2
Job site address:15865 SW OAK MEADOW LN Catch basin or area drain 18.76
City/State/ZIP:TIGARD,OR 97223 Drywdl,leach line,or trench drain 18.76
Footing drain(no.linear fL: ) Page 2
Suite/bldg./apt,no.: 1 Project name:324258 HILTON Manufactured home utilities - 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear 1L:_) Page 2
Storm sewer(no.linear ft.:�) Pagc 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixtare or item:
Tax map/parcel no.: Baeklluw proverlter 1 31.27 31.27
'1 v. y Backweler valve 12.51
*
.' Clothes washer 25.02
INSTALL 3/4"BACKFLOW DEVICE
Dishwasher 25.02
Drinking fountain 25.02
tjectors/sump 25.02
4,;;;'„....:1';', ,. ■ r 1 '2ar Expansion tank 12.51
.C4. .. ' • ., .a,W.w n*WnbNliJi✓.A
..... ....:......E,:::,
Name: HARRY HILTON Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
_ Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice.baker 12.51
25.02
Business name:MP PLUMBING CO Medical gas(value:S ) Page 2
Printer 12.51
Contact name:CINDY CRIVELLONE
_ Roof dram(commercial) 12.51
Address:PO BOX 393 Sink/basin/lavatory 25.02
City/StateZTP:CLACKAMAS,OR 97015 Solar units(potable water) 62.54
Phone:(503)655-9161 Fax:;(503)655-1726 Tub/shower/shower pan 12.51
E-mail:CINDYC®MPPLUMBING.COM urinal 25.02
I 5 1 ,u. �ab%•r e , ,,,a Water clime t 25.02• w a !;1
37.52
Business name:MP PLUMBING CO water piping/DWV 56.29
Address:PO BOX 393 Other; 25.02
City/Statc/ZIP:CLACKAMAS,OR 97015 Subtotal 31.27
Phone:(503)655-9161 Fax:(503)655-1726 Minimum permit fee: S72.50 72.50
Plan review (25%of permit fee)
CCB Lie.:5002 Plumbing Lie.no.:3-17PB
• State surcharge(12%of permit fee) 8.70
Authorized signature��� TOTAL PERMIT FEE 81.20
Print name: Dale: This permit application expires H a permit b NM Obtained within lad days
(11./\ett Cpl V�i!rlY(.� I 3 T�-� after h been accepted as eoslplete.
`fee methodology set by 7Yi-Crmty Ruikling Industry Service Rnnrrt
1:41eildug\Permas1el,Mil.rmaMApp,4.1oc 10100119 400.46167(10107100M/WEB)