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Permit (95) CITY OF TIGARD PLUMBING PERMIT 71I ' COMMUNITY DEVELOPMENT Permit#: PLM2017-00183 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/17/2017 T f 0. `O 9 Parcel: 2S111 BB01800 Jurisdiction: Tigard Site address: 10350 SW AMANDA CT Project: HARBICK Subdivision: None Lot: None Project Description: Backflow preventer for irrigation. Contractor: OREGON LANDSCAPE Owner: HARBICK, CHARLES C PO BOX 1265 16167 SW RAILROAD ST CLACKAMAS, OR 97224 SHERWOOD, OR 97140 PHONE: 503-855-4976 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 05/17/2017 $31.27 Specifics: 1 12%State Surcharge- 05/17/2017 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 05/17/2017 $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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23or 1.800.3 344. E Issued By: Permittee Signature: ` � i/_tet._ _ 40 Call 503.639.4175 by 7:00 a.m.for the next available inspec' date. This permit card shall be kept in a conspicuous place on the job site unti 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 TI andi Received `/ Date/By: S 7/17 Penn it No. Ain:pc 7 -a) D3 1( H125 SW Hall Blvd.,Tigard,OR 97? . "' v7� Phone: 503.718.2439 Fax: 19 - DPlan Review Other Permit No.. � Date/By: TIGARD Inspection Line. 503.639.41 1 Date Ready/By: Jars ® See Page 2 for Internet: www.tigard-or.gov r, 1 riS5 t Notified/Method Supplemental Information TYPE OF WO N \ g * FEE* SCHEDULE ❑ New construction nit -51v -_ For.special injorrnntio,i use checklist, +��yy \ ,_Descrjuon _ 1 Qt, ± a. 1 Total [�' Addition/alteration/replacement ( yJ let - New I 2-family dwellings(includes 100 It for each utility connection) CATEGORY OF CON t`i ON SFR(1)bath 312.70 © I-and 2-family dwelling' INCommercial/industrial SFR(2)bath 437.78 Li Accessory buildingSFR(3)bath 500.32 ❑ Multi-family Each additional bath/kitchen 25.02 ❑ Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 l JOBSITE INFORMATION AND LOCATION 1 Site utilities: _ Job site address: ii, Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/Z1P: J‘' '`t 07/' (i2.�t/\ Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no . Project name.: d✓V/C� 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.:_) I Page 2 -- Water service(no. linear ft.: ) Page 2 Subdivision: _ Lot no.', 1 Fixture or item: - Fax map/parcel no.: Backflow preventer C 31.27 ....4t' 7 DESCRIPTION OF WORK Backwater valve 12.51 r Clothes washer 25.02 IC Jlo;N PtC.-,�(vrk,- f-ai . -rr,J4'`I 4\ -5 s. efl-t I- ,y- Dishwasher 25.02 Drinking fountain 25.02 II- { - -- ! L:jectors/sump - - -- 25.02 =-- - - ' ® PROPERTY OWNER ❑ TENANT_' I_.xpansion tank [ - 12.51 Fixture/sewer cap 25.02 Name: 6-114" 5 jot"/b.Gi< Floor drain/floor sink/hub 25.02 Address: j Le 3. 41 50Ci-2t L14, f�r - � VJ -- Garbage disposal 25.02 City/State/ZIP: 1'G)pj/L/ C) 7.22`-/ Hose bib 25.02 1 Phone.( ) JJ Fax.( ) Ice maker 12.51 ® APPLICANT ❑ CONTACT PERSON 1 Interceptor/grease trap 25.02 1Business name: � Medical gas(value:$ ) j Page 2 1 -- _ _v,�-y(1,, �.441..� 6t - -- ----- Primer 12.Si 1 Contact name: 2-G &4� (22 rd - Roof drain(commercial) 12.51 Address: Q 0 _ 1 5,,, 26 I Sink/basin/lavatory 25.02 City/State/Z11): 6_14.6.ki 1i1 ore, q 2a/5 Solar units(potable water) 62.54 Phone: (503) 172-by'2C Fax: :( ) Tub/shower/shower pan 12.51 Urinal 25.02 I mail j�,667 �/� a�f �f 6.1I ei c' . eerk, Water closet I 25.02 V CONTRACTOR -- - -- - --- Witter heater 37.52 Business name 0,1 til ;r. ,✓,..;W7t.�--4C..Ly_ � Water piping/[)WV 56.29 Address C 4, 2C,� ,� Other 25.02 ---- ------------ City/State/ZIP. � � �:�y,tit �`;rte t���zi_ I Subtotal ?ii. '77 Phone:( 10.,:A / - L'y 5 Fax:( ) Minimum permit fee: $72.50 7.-,7-. 0 CCB Lie._/„L f w,..3.,,,..,:),.6C j p Jj r I 1 Plumbing Lic. no.. Plan review (25%of permit fee) L --- State surcharge(12%of permit fee) i.70 Authorized signature: - ._ I _ _° �" L TOTAPERMI I FLT r3 i.�1� - ,(3.,,,i-,,, This permit application expires if a permit is not obtained within ISO days Print name tel„ ,'� L" Date: 3._/�_%)i � after it has been accepted as complete. 'ice methodology set by Tri-County Building Industry Service Board, i-1Budding l Primits\P1 511-Penni!App.doe IO/0109 44G-lo I6T110/03/COAL/Vi BI31