Permit CITY OF TIGARD PLUMBING PERMIT
111P1 R- rr COMMUNITY DEVELOPMENT Permit#: PLM2014-00144
Date Issued: 05/05/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134DA01400
Jurisdiction: Tigard
Site address: 11095 SW 106TH AVE
Project: Tuggle Subdivision: NORTHERN PINE Lot: 5
Project Description: Residential irrigation backflow device.
Contractor: OWNER Owner: TUGGLE, AMANDA
11095 SW 106TH AVE
PORTLAND, OR 97223
PHONE: 971-235-3269
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/05/2014 $31.27
Specifics: 1 12%State Surcharge- 05/05/2014 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/05/2014 $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 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. ` /fin
1N
Issued By: Permittee Signature: �/-/- L/� -/ /dN
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.
05/01/2014 13:00 5034949277 OCTRI PAGE 01/02
Plumbing Permit Applicati �l !
Building Fixtures i 1 T I t ll. i tl1 11 I I "I 11\I
, Received /0L�'-1 `/
City of Tigard Da1� ,S S /
,,,e ilia ern N� 20/ DO/
IIIIII R 13125 SW Hall Blvd.,Tigard,OR 97221 Plan Review
• Phone: 503.718.2439 Fax: 503,598.1960 D��gy, Other Permit No.'
- Inspection Line: 503.639.4175 CITY Ur i iUf'tf1L Date Rcady/13y; !uric 1Z See Page 2 ger
1 ` 1:i' Internet: www.tigard-or.gav `AI1tot1', Notified/Mothod -- _ Supple
- fir. 71�`.IN w ... � ,yi ..n !.I✓,� ...;i � i .
New construction ❑Demolition For special Information use checklist.
Description I Qty. I Ea, 1 Total
❑Addition/alteration/replacement ❑Other: New l-2-family dwellings(includes 100 ft.for each utility connection)
4y ..,.-...r.',:=« ,,« t 't*Avvo , t.: w y SFR(1)bath 312.70
®1-and 2-family dwelling ❑Commercial/industrial
SFR(2)both 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Bach additional bath kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.fl.) Page 2
s l.W:r. iS g.rifie r".w sum gli.. .,.� ,, Y j * t.4: ' 4 ""1 1' + r 1 Site utilities:
Job site addresa: 11095 SW 106"Ave Catch basin or area drain 18.76
Drywcll,leach line,or trench drain 18.76
City/State/ZiP:Portland,OR 97223 Footing drain(no.linear ft.' ) Page 2
Suite/bldgJapt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 111 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:,_„•,) Page 2
Storm sewer(no.linear ft.: Page 2
Water service(no.linear ft.:_ ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel nn.' Backflow preventer I 31,27 31.27
' ,:„.,4•..,.-.:,..,4.:.-..:-.7 r 1., Backwater valve
��G 1 'f e ' ;; i ' �tr P ' 'rw ; t 12.51
Cloches washer 25.02
irrigation system was already installed when 1 purchased the house. Dishwasher 25.02
Need to get permit to be in compliance with city code. Drinking fountain 25.02
Ejectors/sump 25,02
N 1 j,.= L, Expansion tank 12,51
Name:Amanda Burrell(Tuggle) Fix re/sewer cap 2 5.02
Floor drain/floor sink/hub 25,02
Address:11095 SW 1061"Ave
Garbage disposal 25.02
City/Statc/ZIP:Portland,OR 97223 Hose bib 25.02
Phone;(971)235-3269 Fax:( ) lee maker 12,51
y
+i r7;, r la: ol , Q Interceptor/grease trap 25.02
Rusin;: . . ate,
css name:
Medical gas(value:$ ) Page 2
Primer 12,51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25,02
City/Statc/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
`r ,, Water closet 25.02
�
„fu t.,. Water heater 37.52
Au5iness name:Owner Water piping/DWV 56.29
Address: Other 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) - Minimum permit foe; $72.50 -7.2,sv
CCB Lic.: Plumbing Lie.no,: Plan review (25%of permit fee)
State surcharge(12%of permit fee) - , 70
Authorized signature: TOTAL J TOTAL PERMIT FEE 81.20 r•
Print name:Amanda Worrell Date:05/01/2414 This permir application expires If a permit is not obtained within ISO days
after it has been accepted as complete.
"rec methodology set by Tri-County Building industry Service 13oend,
11 nuilding\PermltetPLM11-Perml,App.dcc I0/01/Sfl 440_4018T(10/02/COM/WEB)