Permit CITY OF TIGARD PLUMBING PERMIT
! COMMUNITY DEVELOPMENT Permit#: PLM2014-00240
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/22/2014
Parcel: 2S114BB20100
Jurisdiction: Tigard
Site address: 16571 SW 103RD AVE
Project: JONES Subdivision: RIVERVIEW ESTATES NO.2 Lot: 45
Project Description: Backflow for irrigation.
Contractor: SOUTHWEST LANDSCAPE LLC Owner: JONES,WILLIAM D&SANDRA ANN
8859 SW COMMERCIAL ST 16571 SW 103RD AVE
TIGARD, OR 97223 TIGARD,OR 97224
PHONE: 503-620-0149 PHONE:
FAX: 503-620-0590
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/22/2014 $31.27
Specifics: 41 ea Minimum Fee Adjustment- 07/22/2014 $41.23
Plumbing
Type of Use: SF 1 12%State Surcharge- 07/22/2014 $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 co. of the s
or direct questions to OUNC by calling 503.232.1987 or 1.$09332_.2344.
L /
Issued By: Permittee Signature: /
Pr
Call 503.• • •y 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.
t� ri
Plumbing Permit Applicati ��� FOR OFFICE USE ONLY
�t Received 1 tx City of Tigard ���� Plan Re. -7/ fi ei PermitNo.:P/�n�Di(f_ tic
r 13125 SW Hall Blvd.,Tigard,OR 97223 V Plan Review / y I ' 'l
Phone: 503.639.4171 Fax: 503.598.196O ,�q►� eBy, Other Permit No.:
TIGARD Inspection Line: 503.639.4175 (CO 1" to Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov ,` C3 �l Notified/Method: Supplemental Information
TYPE OF WORT{ , FEE* SCHEDULE
❑New construction ❑DertHQ tion For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 350.00
❑Accessory building ❑Multi-family SFR(3)bath 399.00
❑Master builder Each additional bath/kitchen 45.00
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address:\ �—\\ � . \ Ca' A�>(____ Catch basin or area drain 16.60
City/State/ZIPr \%A--- ( - �-�4 Dtywell,leach line,or trench drain 16.60
Suite/bldg./apt.no.: Project name ,1� � �CJ Footing drain(no.linear ft.:_) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Water service(no.linear ft.:_) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
ail DESCRIPTION OF WORK
Backflow preventer Page 2
/ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ TENANT
Ejectors/sump 16.60
Name: c&, & �� � Expansion tank 16.60
Address: \t „.c:-.)',\ „'> . `O3 A-Q-� Fixture/sewer cap 16.60
City/State/ZIP: v c„.. _c\ CJ a 3t- Floor drain/floor sink/hub 16.60
Phone:( ) l Fax:( ) Garbage disposal 16.60
❑ APPLICANT }f ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor/grease trap 16.60
Contact name: Medical gas(value:$ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain(commercial) 16.60
Phone:( ) I Fax::( )
Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: )(- �, � ems\ . CG Water heater 16.60
Address --i%e7 .. _ C £mN -- -- ,CKc . ,',\ Other:
City/State/ZIP.�\(`�G - �'. (I G'�.)'aa Subtotal ��.�D
Phone: L Minimum permit fee: $72.50
(jo )Lo'���,\�C\ Fax:( ) Residential backflow minimum permit f e e: $3 6. ,..'ng Lic.no.: Plan review (25`%2of permit fee)
{{ State surcharge{99rc��)— .?V
Authorized signature
`� '`
L/_�°' TOTAL PERMIT FEE
Print nam \- Date-77—D\J\`"l This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLM-PennitApp.doc 06/26/06 440-46 I 6T(I 0/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16571 SW 103RD AVE, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00240
David Young
Violation Summary:
Inspector Contractor