Permit (67) CITY OF TIGARD PLUMBING PERMIT
11111
a COMMUNITY DEVELOPMENT
Permit#: PLM2018-00368
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439Date Issued: 07/26/2018
T f A I<.[� Parcel: 2S111CB04500
Jurisdiction: Tigard
Site address: 10434 SW LADY MARION DR
Project: Rhode Subdivision: MARION ESTATES Lot: 18
Project Description: Replacing backflow preventer for landscape irrigation.
Contractor: CM LANDSCAPE LLC Owner: ROHDE, CHRISTOPHER J&KA KI
PO BOX 1638 10434 SW LADY MARION DR
NORTH PLAINS, OR 97133 TIGARD, OR 97224
PHONE: 503-608-8650 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/26/2018 $31.27
Specifics: 1 12%State Surcharge- 07/26/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 07/26/2018 $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 to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: tlPermittee Signature:
":4A±35L-
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.
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tint Permit Applicatid�t►3 - ,' V -1-
Site-Utilities-
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Site Ut l:ti.a- JUL 2 6 2018
City of Tigard Ni Received 7 26. tri Q�J[ /411‘020/
9n �0/i�1 D/ I-
TY O i a e! DateBy: �Nv Permit 1 / L1/J�(G�'
13125 SW Hall Blvd.,Tigard,OR ' r ct , ,
"d'l( ,-,,1\tS� 'tPlan Review
f Phone: 503.718.2439 Fax: 5031:- ':. !it' ' '' Date/By: Other Permit No.:
TIG\R l7 Inspection Line: 503.639.4175 Date Ready/By: Juds: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10434 SW Lady Marion Dr. Catch basin or area drain 18.76
City/State/ZIP: Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer ( 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replacing existing backflow
Dishwasher 25.02
Drinking fountain 25.02 1
Ejectors/sump 25.02
El PROPERTY OWNER 1 0 TENANT Expansion tank 12.51
Name:Chris Rhode Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:10434 SW Lady Marion Dr. Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
►4 APPLICANT �� CONTACT PERSON Interceptor/grease trap 25.02
Business name:CM Landscape LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Antonio Mendez
Roof drain(commercial) 12.51
Address:PO Box 1638 Sink/basin/lavatory 25.02
City/State/ZIP:North Plains,OR 97133 Solar units(potable water) 62.54
Phone:(503)608-8650 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:cmlandscapeor@yahoo.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:CM Landscape LLC Water piping/DWV 56.29
Address:PO Box 1638 Other: 25.02
City/State/ZIP:North Plains OR 97133 Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 193693 Plumbing Lic.no.: e31 '
a/LAD/47._../fV/l, / State surcharge(12%of permit fee)
/
Authorized signature: - TOTAL PERMIT FEE
Print name:Maricela Mendez Date:7/25/ 018 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:\Building\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:
10434 SW LADY MARION DR, TIGARD, August 6, 2018 at 1 :44:44 PM
OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2018-00368
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
New Febco irrigation backflow device model 850 ser#58650 located by meter approved
with test report.
Violation Summary:
Inspector Contractor