Permit (60) CITY OF TIGARD PLUMBING PERMIT
N.,„ 41
2 COMMUNITY DEVELOPMENT Permit#: PLM2018-00067
Tf aAR1D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/22/2018
Parcel: 2S108DB05900
Jurisdiction: Tigard
Site address: 15361 SW SEINE DR
Project: FELL Subdivision: POLYGON AT BULL MOUNTAIN Lot: 57
Project Description: Backflow preventer for landscaping.
Contractor: OREGON LANDSCAPE Owner: FELL, CHRISTINA M&JORDAN A
PO BOX 1265 15361 SW SEINE DR
CLACKAMAS, OR 97224 TIGARD, OR 97224
PHONE: 503-855-4976 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/22/2018 $31.27
Specifics: 1 12%State Surcharge- 02/22/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 02/22/2018 $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 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
/•(‘
e%7747zez . h..,
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 IV FOR.OFFICE i.USE ONLY
City Of Tigard
@¢ Iteeenui p '
�'� 31 5 SW Hall Blvd,.'1'igard.OR 97223 2RIt fie __ /�Fi�� {-ennit No i ����/j?
Phone: 50x.718 2439 Fax: 503.5.98.!960 FEB 0 2018
Plan Review
O
Inspection Line 503.639.4175 .)ue Fly: OtherPennit No.'�`� _
CITY
d� TIG
/� X20/J OU3?
TIGRIS VI �J1VlPl Date Ready/By. ---luri>
Internet: www ugard-or eov i 0 See Page 2 for
pUli-DING- V1. uuli�d Method Supplemental Information
TYPE OF WOR♦ &t'�� �7! INE* SCHEDULE
❑ New construction ❑ Demolition I For special rrrforntnlion rise checklist.
----------- Description < t I
CZ Addition/alteration/replacement ❑Other. \t�_I-2-familydwellings(includes I(10 � FTotal
lbr each utility connection)
CATEGORY OF CONSTRUCTION -
SIR(1)bath _ 312.70
I we
and 2-family dwelling -_-
- - g - ❑Commercial/industrial
SFR(2)bath -( - 437.78
®
❑Accessory building --- -- I SFR(3)bath 500.32
❑ Multi-family
❑ Master builder Each additional bath/kitchen 25.02
❑Other.
Fire sprinkler( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION - -
_---- - ---------_._ Site utilities: •
Job site address: 15361 SW Seine Dr Catch basin or area drain �-
18.76
City/State/![--: Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: Project name: Footing drain(no.linear ft.: ) Page 2
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
r
• r Storm sewer(no. linear 1-1.: i Page 2 I
�Water vice(no. linear ft Page 2ISubdivision
- ---- I Lot no.: Fixture
or item' _ - -
[ah map/parcel no
Back flow preventer
_ _ I 31.27 31.27
_-- -- DESCRIPTION OF WORK Backwater valve - - I Z.51
Installation of backflow preventer for irrigation system Clothes washer 25 02
------------______
Dishwasher 25.02
--- Drinking fountain 25 02
- - ------ - f- -
i t lectors/sump
L _ 25.02
®PROPERTY OWNER 1 ❑ -- i -
`TENANT I hpansion tank _ I 12.51
Name:Jordan& Christina Fell I Fixtur' seecer cap • 25.02
-
Address: 15361 SW Seine Dr Floor drain/floor sink/hub 25.02
City/Stale/ZIP: Tigard,OR 97224 Garbage disposal 25.02
I__-_------Ii Hose bib
Phone (503)332-7540 25.02
- Fax ( ) Ice maker
__ 1251
� ® APPLICANT 1 11 CONTACT PERSON Interceptor/greasetrap
- - - 25.02
renes,name: Oregon Landscape
- - - --_
Medical giis(kalm::S ) Pi_e 2 1
ontai t it une. anon Booth - Primer J I
12 -I-:- ---
Rool dram(commercial) 12.51
Address: PO Box i265
-�- --
Sink/basin/Itvatoly } "
Ci
Cty/Stile/7,IP:Clackamas,OR 97015 _ 2 5.02
- Solar units(potable water) 62.54
Phone:(503)855-4976 Fah: : --
( ) - Tub/shower/shower pan 12.51
E-mail jasonrjaoregonlandscape.com --
Urinal
25.02
---- CONTRACTOR Water closet _ 25.02
- hea(c.I -
I - --
i.,:fs..;p L '' 52
- --.---- I Water piping/DW� c
---
Address PO Box 1265 - -" - ?6.s�
Other 25.02
City/StateiZlP. Clackamas,OR 97(115 -- --- - -
Subtotal 31.27
Phone:(503)855-4976 Fax:( )_ _ Minimum permit fee' $72-50 72,50
CCB Lie.: LCB#8864 Plumbing L is no - Plan review (25'4,of permit feei --
Authorized Ign Ih
State lurch trge(12'';'0,1o,f permit tee) 8.70
-.- -
i, - IOT.2\ L RMI i t 1 G 81.20�
tllll name: Jason Borth4.
IIs t,ermit ippllcation expo •s d I pe-iul i us not obtained Fviihn. 180 dans
D;nc 2.12118
--.--- aftrr rt bay bc(n uceptc�l as complcic.
,,l,ec weth(.dcl,m,s I, .,-,ri my lsuil,iiilr Indutitrr tion u_Hoard.
1.ABuildine Pe nuiPt 511 c.ru,'\ n Joe I(1ui/09
44a-101071 0, r 0%!!WU)