Permit (136) CITY OF TIGARD PLUMBING PERMIT
a 1111 ,
II . COMMUNITY DEVELOPMENT
Permit#: PLM2017 00073
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/08/2017
�I Ct7•D' Parcel: 2S110DD04100
Jurisdiction: Tigard
Site address: 15685 SW OLD ORCHARD PL
Project: CONNELL Subdivision: SUMMERFIELD NO.3 Lot: 143
Project Description: Backflow preventer for irrigation.
Contractor: BLESSING LANDSCAPES Owner: CONNELL, NANCY CLOYD LIVING TRUS
7219 NE 47TH AVE 15685 SW OLD ORCHARD PL
PORTLAND, OR 97218 TIGARD, OR 97224
PHONE: 503-284-3557 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/08/2017 $31.27
Specifics: 1 12%State Surcharge- 03/08/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 03/08/2017 $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
'ttoo OUNC by calling 503.232.1987 or 1 :e:. 4. - 4.
Issued By: `� ✓ C --� Permittee Signature: 1
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 ., :1\
City of Tigard w . Received
Datemy, 3 Permit No.: /�`
il 13125 SW Hall Blvd.,Tigard,OR 97223 � 7
Plan Review f N � ��
°: .Phone: 503.7182439 Fax: 503.598.196014 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 tt `, `!
T I G A R D e . r°4„pate ReadyBy: Juris: H See Page 2 for
Internet: www.tigard-or.gov 1 `'
'�.x� s ° Y.i-,r=4 otified/Method: J °' Supplemental Information
TYPE OF WO''U`t2U11° `-A`°O 1 FEE* SCHEDULE
New construction 0 Demolition For special information use checklist
Description Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
-and 2-family dwelling
0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATIONnAND LOCATIONlSite utilities:
Job site address: 85 /4) Old QA C/m'/ Jp/ Catch basin or area drain 18.76
v cl ! Drywell,leach line,or trench drain 18.76
City/State/ZIP: .....710
ey,�� 9. z-1
r !7'�' t Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: (C i 6 o r Manufactured home utilities 50.03
Cross street/directions to job site: 5t s,r� he/C/ pee) Manholes18.76
V ( / Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Stonn sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer r 31.27 X
DESCRIPTION OF WORK Backwater valve 12.51
0') n � 11 Ade- OLd �� /is Clothes washer 25.02
/U f� ( ,Ih` Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
/PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Vga
0�v. 1IFixture/sewer cap 25.02
Cw G Floor drain/floor sink/hub 25.02
Address: 5 , 2 C �LGI P1
Garbage disposal 25.02
City/State/ZIP: i q 101
(aai) � _3 Ci Fax: _ Hose bib 25.02
Phone: ( ) Ice maker 12 5
'APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Ev4 I'm �/^^ / / / Medical gas(value:$ ) Page 2
LL ^ !V( , lj/�C� Primer 12.51
Contact name: (/,J'
Roof drain(commercial) 12.51
Address: V 9 N 4 , AvG_ Sink/basin/lavatory 25.02
City/State/ZIP: `7a - .( i_ `��171/5 Solar units(potable water) 62.54
Phone:( ! v.1 3 5 5 Fax::( ) Tub/shower/shower pan 12.51
E-mail: nj ,I /� l\i M1 AN Cl . p�� Urinal 25.02
/V V U[J��'r� l Water closet 25.02
CO RACTOR
Water heater 37.52
Business name: r' / ,In e41%& GG Water piping/DWV 56.29
Address: w r. v tJ �t�( "� �1 Other: 25.02
City/State/ZIP: � L ! /11,06
�10Ut , Subtotal I sq
Phone:( ) Fax:( ) Minimum permit fee: $72.50 il- D
CCB Lic.: 64 Plumbing Lie.no.:
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: //O
j?../i
TOTAL PERMIT FEE l�Print name: /. /OF Date:3-2. / 9- This permit application expires if a permit is not obtained within 18 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Building'Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15685 SW OLD ORCHARD PL, TIGARD, OR, April 3, 2017 at 11 :22:03 AM
97224
Record Type: Record ID:
Residential - Plumbing PLM2017-00073
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Wilkins back flow preventer located left of driveway model 350 ser# A551805
approved with test report.
Violation Summary:
Inspector Contractor