Permit (38) CITY OF TIGARD PLUMBING PERMIT
1114
�' COMMUNITY DEVELOPMENT Permit#: PLM2019 00255
Date Issued: 06/17/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S114BB08200
Jurisdiction: Tigard
Site address: 16360 SW 104TH AVE
Project: LEE Subdivision: SWANSON'S GLEN Lot: 23
Project Description: Backflow preventer for irrigation.
Contractor: BLESSING LANDSCAPES Owner: LEE, BEN H III &HEATHER A
7219 NE 47TH AVE 16360 SW 104TH AVE
PORTLAND, OR 97218 TIGARD, OR 97224
PHONE:
PHONE: 503-284-3557
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/17/2019 $31.27
Specifics: 1 12%State Surcharge- 06/17/2019 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 06/17/2019 $41.23
Type of Use: SF 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: Permittee Signature: `
Cal 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.
T
Plumbing Permit Application
Site Utilities FOR OFFICE GSE ONE)'
Received
City of Tigard r 'bate/By: / J�c� /,}j� Permit No.: /J(1,, )/c )>3--
13125 SW Hall Blvd.,Tigard,OR 97223 G1-J� ti'
Ian Review
II
UPII Phone: 503.718.2439 Fax: 503.598.19SG pate/By: Other Permit No.:
r I t n It n Inspection Line: 503.639.4175 q®1g Date Ready/By: Imis: H See Page 2 for
Internet: www.tigard-or.gov L Notified/Method: Supplemental Information
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®New construction 0 Demo10 , 1t�G ON\ For special information use checklist
Vl Description Qty. I Ea. Total
❑Addition/alteration/replacement 0 Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF c NffIne SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
' JOB-SITE INFORMTION AMD LOCATION Site utilities:
Job site address:16360 SW 104th Avenue 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.: Project name:Lee 9954 Manufactured home utilities 50.03
Cross street/directions to job site:SW Titan Ln. 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Backwater valve 12.51
Clothes washer 25.02
Install Backflow Preventer
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
1:e, Expansion tank 12.51
Name:Ben&Heather Lee Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:16360 SW 104th Avenue
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:(503)358-6635 Fax:( ) Ice maker 12.51
:4 Ar CANT CD CONT'ACr PEISAiN , " Interceptor/grease trap 25.02
Blessing g Landscapes Medical gas(value:$ ) Page 2
Business name:Bl
Primer 12.51
Contact name:Emily Stiff
Roof drain(commercial) 12.51
Address:7219 NE 47th Ave. Sink/basin/lavatory 25.02
City/State/ZIP:Portland,OR 97218 Solar units(potable water) 62.54 i
Phone:(503)284-3557 Fax::( ) Tub/shower/shower pan 12.51
E-mail:admin@blessingland.com Urinal 25.02
Water closet 25.02
a)Ih1TRAL7OR
Water heater 37.52
Business name:Blessing Landscapes Water piping/DWV 56.29
Address:7219 NE 47th Ave Other: 25.02
City/State/ZIP:7219 NE 47th Ave. Subtotal 31.27
Phone:(503)284-3557 Fax:( ) Minimum permit fee: $72.50 72.50
7, ,i Plan review (25%of permit fee)
CCB Lic.:7843 .2/' Plumbing Lic.no.:
State surcharge(12%of permit fee) 8.70
Authorized signs re: "d / , TOTAL PERMIT FEE
�� 4t���� 81.20
Print name:Stacy Mayfield , Date:6/7/19T_ This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
-Fee methodology set by TTl .tnmty Bulruing Industry Service Brand.
I.\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
16360 SW 104TH AVE, TIGARD, OR, 97224 June 27, 2019 at 10:03:50 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00255
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Wilkins irrigation backflow device model 350 ser#A549412 located by water meter
approved with test report.
Note: plumbing final inspection created(399) to final permit.
Violation Summary:
Inspector Contractor