Permit CITY OF TIGARD PLUMBING PERMIT
111 I • COMMUNITY DEVELOPMENT Permit#: PLM2015-00176
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/02/2015
Parcel: 2S110BC12100
Jurisdiction: TIGARD
Site address: 14818 SW 122ND PL
Project: Troy Park,Lot 7 Subdivision: TROY PARK Lot: 7
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: TRADEMARK LANDSCAPES INC Owner: TIMBERLAND HOMES INC
PO BOX 2410 12670 SW 68TH AVE#300
OREGON CITY, OR 97006 TIGARD,OR 97223
PHONE: 503-631-3893 PHONE: 503-620-8860
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/02/2015 $31.27
Specifics: 1 12%State Surcharge- 06/02/2015 88.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 06/02/2015 $41.23
Class of Work: OTR
Plumbing
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 952-001-00 . You may obtain a copy of the rules
or direct questi•• • S UNC by calling 503.232.1987 or 1.800.332.2344.
Issue• By: . _ /7 v Permittee 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.
Plumbing Permit Application
Site Utilities FOR OFFIC F I s I ()'I 1 n/'
Received / p/n PermitNo.: 0L ;9-V/ -ex,'lee
City of Tigard DareBe: c -/
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ,/
■ Phone: 503.718.2439 Fax: 503.598.1960 nate Ey: Other Perrot No.: 1119T-9C(Y-6,0 c9C''/
Inspection Line: 503.639.4175 Date Ready/By: orris ® See Page 2 for
T I G A-
A K t) Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist
®New construction El Demolition
Description � Qty. 1 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 312.70
SFR(2)bath 437.78
® i-and 2-family dwelling ❑Commercial/industrial SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address:14818 SW 122°d Place -
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:'Troy Park Lot 7 Manufactured home utilities 50.03
Cross street/directions to job site:SW Winterview Drive Manholes 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:Troy Park Lot no.:7 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Backwater valve 12.51
DF OF Clothes washer 25.02
Single Family Residence Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I Cl ricNANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Timberland Homes,Inc.
Floor drain/floor sink/hub 25.02
Address:12670 SW 68°A Ave.,Suite 300 Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)620-8860 Fax:(503)598-9081 Ice maker 12.51
® APPLICANT ❑ CONTACT N Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:Timberland Homes,INc.
Primer 12.51
Contact name:Laura Blake Roof drain(commercial) 12.51
Address:12670 SW 68th Ave.,Suite 300 Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)620-8860 Fax::(503)598-9081 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:laura(ajtimberlandhomes.net - - -Water closet 25.02
CON'JI*ACK& Water heater 37.52
Business name:Trademark Landscapes,Inc. Water piping/DWV 56.29
Address:PO Box 2410 Other: 25.02
City/State/ZIP:Oregon City,OR 97045-4545 Subtotal
Phone:(503)631-3893 Fax:(503)631-4737 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: Plumbing Lic.no.:
//�' ��Q � g ` State surcharge(12%of permit fee)
Authorized signature: `� a 1J TOTAL PERMIT FEE
/ ���; � Date This permit application expires if a permit is not obtained within ISO days
Print name: LAW" ..1,y l!j'p ���.- after it has been accepted as complete.
P�+h '4/ *Fee methodology set by Tri-County Building Industry Service Board.
r\ItuildingPPamits\PI.MU-Per itApp.doc 10Y01n9 440-4616T(O0/O2ICOM/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
14818 SW 122ND PL, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00176
David Young
Test report picked up at previous inspection.
Violation Summary:
Inspector Contractor