Permit Support Document CITY OF TIGARD �°�� PLUMBING PERMIT
IN 7 COMMUNITY DEVELOPMENT Permit#: PLM2019-00412
Date Issued: 10/10/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110BB04100
Jurisdiction: Tigard
Site address: 12176 SW AMES LN
Project: Borelli Subdivision: ARLINGTON RIDGE Lot: 18
Project Description: replace water service. 10/23/2019: REPRINT permit to reduce water service from 150'to 70'and add irrigation
backflow device.
Contractor: FLOW RITE PLUMBING Owner: BORRELLI, GARY&JUDITH LIVING T
19902 SW JAY ST 12176 SW AMES LN
BEAVERTON, OR 97006 TIGARD, OR 97224
PHONE: 503-258-7352 PHONE:
FAX:
FEES
Quantity Description Date Amount
70 If Water Service 10/10/2019 $62.54
Specifics: 1 ea Backflow Preventer 10/10/2019 $31.27
1 12%State Surcharge- 10/10/2019 $11.26
Type of Use: SF Plumbing
Class of Work: ALT 7 Cash Over 10/10/2019 $7.00
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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: 6A ' -/ 0/V
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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 RECEIVED FOR OFFICE USE ONLY
City of Tigard DateBReceivedy:
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Permit N905",..././...,247/ -0,)V,../
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13125 SW Hall Blvd.,Tigard,OR 97223 OCT 2 3 2019 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: Ea See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
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❑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)
G , TONT i t I , 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
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SITE INFOR a Int 0 IND
L I Site utilities:
Job site address:12176 SW AMES LN. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD, OR 97224
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.: 70) 1 Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27 DEsCiOricK4 OP' air Backwater valve 12.51
Clothes washer 25.02
REPLACE WATER SERVICE LINE AND BACKFLOW PREVENTER Dishwasher 25.02
/a'fr'o%./ /°1-1-/P-o/9 -60 if 4A T S.7" Drinking fountain 25.02
41 A/ ,7- a F cei' 2. L 7 o`I f Ejectors/sump 25.02
®'t -0,0,74 ;, -....;,i,-;:'i‘,‘,
'. ` Expansion tank 12.51
Name: / e--111---. "-ti�'"vg. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
� LIlCtY eiu 7OINTACT PERSON Interceptor/grease trap 25.02
Business name:AKA ENTERPRISES, INC dba FLOW-RITE PLUMBING Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:DEAN SPENCER
Roof drain(commercial) 12.51
Address:19902 SW JAY STREET Sink/basin/lavatory 25.02
City/State/ZIP:BEAVERTON, OR 97003 Solar units(potable water) 62.54
Phone:(503 )914-7285 Fax: :(503 )214-8423 Tub/shower/shower pan 12.51
E-mail:flow-riteplumbing@live.com Urinal 25.02
-- Water closet 25.02
CON'I'1tACT'OR
Water heater 37.52
Business name:same as above Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 93.81
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.:1969366 Plumbing Lic.no.:PB 1194 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 11.26
Authorized signature: �� TOTAL PERMIT FEE 105.07
Print name:Cohen K. Pea Date:10/23/19 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.
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