Permit (3) CITY OF TIGARD PLUMBING PERMIT
11111 q
a COMMUNITY DEVELOPMENT Permit#: PLM2019-00403
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2019
Parcel: 2S104BA12800
Jurisdiction: Tigard
Site address: 13710 SW MARCIA DR
Project: MOREJON Subdivision: CASTLE HILL NO.3 Lot: 158
Project Description: Backflow preventer for landscape irrigation.
Contractor: TRYON CREEK LANDSCAPE INC Owner: MOREJON, GREG&TARA THUY
11400 SW NORTH DAKOTA ST 13710 SW MARCIA DR
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-869-0257
HONE: 503-624-2174
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/07/2019 $31.27
Specifics: 1 12%State Surcharge- 10/07/2019 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 10/07/2019 $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. T e rules are set 'rth in 0' 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC calli g 50 . 32.197 or 1.801 - .2344.
Issued By: / / mittee Signature: F
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 Ap licatio EWE -°
Building Fixtures FOR OFFICE USE ONLY
OCT 7 2019 Received
City of Tigard Date/By:is-21, J / 1f -, .- O J s13
lig
13125 SW Hall Blvd.,Tigard,OR 972201TY OF I CARD
Phone: 503.718.2439 Fax: 503.59 Plan Review
MEDING DIVISION Date/By: Other Permit No.:
T)G A R D Inspection Line: 503.639.4175 Date Ready/13y: Juris: E 1 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction El 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(1)bath 312.70
® 1-and 2-family dwellingSFR(2)bath 437.78
0 Commercial/industrial
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:13710 SW MARCIA DRIVE Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD/OREGON/97223
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:SW NORTHVIEW DRIVE 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 1 31.27 31.27 1
I
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
INSTALL DOUBLE CHECK BACKFLOW PREVENTER FOR LANDSCAPE Dishwasher 25.02
IRRIGATION. Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:GREG MOREJON Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:13710 SW MARCIA DRIVE
Garbage disposal 25.02
City/State/ZIP:TIGARD/OREGON/97223 Hose bib 25.02
Phone:(503)869-0257 Fax:( ) Ice maker 12.51
® APPLICANT EI CONTACT PERSON Interceptor/grease trap 25.02
Business name:TRYON CREEK LANDSCAPE INC. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:KEVIN DURRELL
Roof drain(commercial) 12.51
Address:11400 SW NORTH DAKOTA STREET Sink/basin/lavatory 25.02
City/State/ZIP:TIGARD/OREGON/97223 Solar units(potable water) 62.54
Phone:(503)793-2647 Fax::( ) Tub/shower/shower pan 12.51
E-mail:kdarrell@tryoncreek.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:TRYON CREEK LANDSCAPE INC./STACEY WERNER WaterPiP t in WV 56.29
Address:11400 SW NORTH DAKOTA STREET Other: 25.02
City/State/ZIP:TIGARD/OREGON/97223 Subtotal 31.27
Phone:(503)624-2174 Fax:(503)624-9880 to/3/7/T Minimum permit fee: $72.50 72.50
3/`t /A! Plan review (25%of permit fee)
CCB Lie.:185802 [ / Plumbing Lie.no.:LCB#6296 -
State surcharge(12%of permit fee) 8.70
Authorized sign TOTAL PERMIT FEE 81.20
Print name:KEVIN DURRELL Date:8/07/19 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.
I:\Building\PermitslPLMU-PermitApp.doc 10/01/04 440.4616T(10/02/COM(WEB)