Permit 1y p CITY OF TIGARD PLUMBING PERMIT
111 • COMMUNITY DEVELOPMENT Permit#: PLM2015-00295
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/09/2015
Parcel: 2S 1040000800
Jurisdiction: Tigard
Site address: 13701 SW 130TH PL
Project: Archer Subdivision: MOUNTAIN HIGHLANDS Lot: 7
Project Description: Replace existing backflow preventer
Contractor: MTZ LANDSCAPE LLC Owner: ARCHER, MARGARET A
2060 S BEECH ST 13701 SW 130TH PL
CORNELIUS, OR 97113 TIGARD, OR 97223
PHONE: 503-929-3042 PHONE: 408 621-1407
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/09/2015 $31.27
Specifics: 1 12%State Surcharge- 09/09/2015 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 09/09/2015 $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
Utilit otification ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or irect questions to O C b - ing 503.232.1987 or 1.800.332.2344.
ssued By: / 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
Building Fixtures FOR OFFICE l ■I O\I ,
Received
City of Tigard ( (�`E I V E D may. 9/c/Y/5 0� !/� Permit No.: 9/I/S_6Oig CJ 5
• 13125 SW Hall Blvd.,Tigard, R �7t Plan Review 1f�/ vv
U Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit No.:
T I GA R D Inspection Line: 503.639.4175 SEP 9 2015 Date Ready/By: Juris 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF ell v, I 4 • I FEE* SCHEDULE
gt) teg\elG Il ti"S;O�j
❑New construction emolifton For special information use checklist
Description I Qty. I Ea. I Total
ddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) _
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
ry 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:
Job site address: J /7/-0/ _(N �0/ y� Catch basin or area drain 18.76
City/State/ZIP: s�-� ��J p� Drywell,leach line,or trench drain 18.76
/ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 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: Lot no.: Fixture or item:
Backflow preventer 1 31.27 3/,;2.7
Tax map/parcel no.: //
DESCRIPTION OF WORK Backwater valve 12.51
�� Clothes washer 25.02
�, f"!Q �/✓ I C li e It r Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
le4-ROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture/scwer cap 25.02
Name: Par 0/7 C' t ./1 L Floor drain floor sink/hub 25.02
Address: `3/ S(f/ ?t) Pt/ Garbage disposal 25.02
/� � 0/S Po
City/State/ZIP: Qi,.� p� 7? 2 7 Hose bib 25.02
Phone:(yd 8 _/9 p7 Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: fl7 /��`js-r-//p/4"0. GC Medical gas(value:$ ) Page 2
/� v� Primer 12.51
Contact name: N 1(/i ti/ �
(� T/ Roof drain(commercial) 12.51
Address: 20 6---- „, ,sc jia?.=.c -.V7 Sink/basin/lavatory 25.02
City/State/ZIP: 6::)/2 &-//j7f 'OA- 7,Z//3 Solar units(potable water) 62.54
Phone:(,_5"dy. ? -?_ -7U y-. . Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: /1477-Z. Zfil/asC7/2 1. 't L Water piping/DWV 56.29
Address: e Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 70/.
CCB Lic.: 8'5 5? 0( I 11/ Plumbing Lic.no.: 637.1" Plan review (25%of permit fee) v
y� State surcharge(12%of permit fee) O.
Authorized signature: , /Y, ,frAi Z �7. TOTAL PERMIT FEE g / go
Print name: // `i T 6,-.:-2_ Date: `' r - 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.
I\BuildingtPermas\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/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
13701 SW 130TH PL, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00295
David Young
Replacement backflow devise in existing location.
Febco model 850, serial # HD64998
Violation Summary:
Inspector Contractor
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
13701 SW 130TH PL, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00295
David Young
Replacement backflow devise in existing location.
Violation Summary:
Inspector Contractor