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Permit (223) CITY OF TIGARD PLUMBING PERMIT ri‘t .'' COMMUNITY DEVELOPMENT Permit#: PLM2016-00594 TCCaA:RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/06/2016 Parcel: 2S110BA12100 Jurisdiction: TIGARD Site address: 14177 SW 118TH CT Project: Medallion Meadows, Lot 14 Subdivision: MEDALLION MEADOWS Project Description: Backflow preventer for irrigation. Lot: 14 Contractor: AUSTIN BROWN LANDSCAPE Owner: JT ROTH CONSTRUCTION INC PO BOX 14441 FOUR D CONSTRUCTION CO PORTLAND, OR 97293 12600 SW 72ND AVE#200 TIGARD, OR 97223 PHONE: 503-887-7795 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 12/06/2016 $31.27 Specifics: 1 12%State Surcharge- 12/06/2016 Plumbing $8.70 Type of Use: SF 41 ea Minimum Fee Adjustment- 12/06/2016 $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 952-001-0.•I. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / Issued By: Permittee Signature: ��j. 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 USE ONLY City of Tigard Received a 13125 SW Hall Blvd.,Tigard,OR 97223 111 � Date/By: ail S Permit No.: /� Plan Review l '7- t q � Phone: 503.718.2439 Fax: 503.598.19 jI(.� _ Inspection Line: 503.639.4175 Date/By: Other Permit No. � 0 T1GAItD g g lI3\6 Date Ready/By; � � its U .� Internet: www.ti and-or. ov Jnris: I ® Sec Page 2 for DC Notified/Method: rD Supplemental Information TYPE OF WORK L s:•kkFEE* SCHEDULE ew construction ❑ Den-1°0.0 A)1��9.1 For5,ecial information use checklist Addition/alteration/replacement Descri tion Qt Ea. Total ❑Oth..j, ��q1� New 1-2-family dwellings(includes 100(I.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 X I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ❑ Multi-family SFR(3)bath 500.32 ❑Master builder Each additional bath/kitchen 25,02 ❑Other: Fire sprinkler(i sq.ft.) Page 2 JOB SiTE INFORMATION AND LOCATION Site utilities: Job site address: j ♦ / -- Catch basin or area drain 18.76 �,,.J / / i 1.. City/State/ZIP: 1 (-61a r' Dtywell,leach line,or trench drain 18.76 Suite/bldg./apt.no.: f f Footing drain(no.linear P.: ) Page 2 Project name: W1, 0416 anufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear It.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision: I Water service(no.linear ti.: ) Page 2 Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 1 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02gvit K .- q"," itsii4-4 Drinkingfountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 City/State/ZIP: Garbage disposal 25.02 Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: ����y� ( Medical gas(value:$ ) Page 2 Contact name: v l 11n7C��nn Primer 12.51 �1 �'F � Roof drain Address: P. l(commercial) 15.01 �X' is.-2 � Sink/basin lavatory 25.02 City/State/ZIP: L3 0 ©- Solar units(potable water) 62.54 Phone:( ;3) 720 S Fax:: ), f. /75/ Tub/shower/shower pan 12 51 E-mail: )cijz CANS- /(/ISS% Ccs Urinal 25.02 CONTRACTOR - Water closet 25.02 Water heater 37.52 name: 6) _v^nvr �esP 5f! ' ater pipinglDWV 56.29Address: jU A'� ,n Other: 25.02 City/State/ZIP: roPt- „(ip q/L� � � / 7 Subtotal ( ) 7 1 Fax:( ) Minimum permit fee: $72.50 "7,„CCB Lic.: umbing Lic.no.: Plan review (25%of permit fee) ' Authorized signature: State surcharge(12%of permit fee) `1-7 d Agle TOTAL PERMIT FEE er/, Print name: ` Datele- / 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. f\Building\Permits\PLMU-PermitApp doe 10,01/09 440-46t6T(I0,02,COM/WEB)