Permit IIIIII4, CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Permit#: PLM2019-00455
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/21/2019
Parcel: 1S135CD00300
Jurisdiction: Tigard
Site address: 11485 SW GREENBURG RD 1
Project: The Birches Apartments Subdivision:.HERS ADDITION TO GREENBURG HE Lot: 4
Project Description: Backflow preventer for irrigation.
Contractor: MP PLUMBING CO Owner: VHR CO LLC
PO BOX 393 PO BOX 66362
CLACKAMAS, OR 97015 PORTLAND, OR 97290
PHONE: 503-655-9161 PHONE:
FAX: 503-655-1726
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/14/2019 $31.27
Specifics: 1 12%State Surcharge- 11/14/2019 $8.70
Plumbing
Type of Use: MF 41 ea Minimum Fee Adjustment- 11/14/2019 $41.23
Class of Work: ALT 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: /7 .', Permittee Signature: / .
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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Building Fixtures NOV 1 2, 20 FOR OFFICE. USE ONLY
Ci of Tigard Received
t - `'r Il ( Date/B : /`r Jf- r'� Permit No.:
• 13125 SW Halt Blvd.,Tigard,OR 97223 y i f r � rn'L/✓1l r`4.-)4/5-c---
Date/By:
Phone: 503.718.2439 Fax: 503.598.1960 '' 1 '�" Plan Review Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 Date Read/B Jori: ®See Page 2 for
TIGARD Internet: www.tigard-ocgov Notified/Method: Supplemental Information
TYPE OF WORK FEE•:.SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description r Qty. I Ea. 1 Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF.CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
t i I.l g S S r �� Rd Catch basin or area drain 18.76
Job site address: i L I t�
�(t t r 3 q 7 aki 5 Drywell,leach line,or trench drain 18.76
City/State/ZIP: JJq tJ d`' /� Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 1�'rCJGS 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 .4.. 31.27 `>,
DESCRIPTION OF.WORK Backwater valve 12.51
R4(j ) t ! r Clothes washer 25.02
lo�ce .iiJ- ® Q"GII i'Ix� lie�e Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 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
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: M p pi Medical gas(value:$_) Page 2
i Primer 12.51
Contact name:
A353-ct ri��
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: p b� -r ori, Urinal 25.02
�E nt G r pI wry Water closet 25.02
CONTRALfOR
a I - Water heater 37.52
Business name: MI V11A1y}bt4g Water piping/DWV 56.29
Address: rU 80x 353 Other: 25.02
City/State/ZIP: (,1 .r kcalita / oil '/7015 Subtotal 31'; .,7
Phone:(C�3) &CJG, 1101 Fax:(5,,a,..) 50 700 Minimum permit fee: $72.50 72,...50
Plan review(25%of permit fee)
CCB Lie.: ',. Plumbing Lic.no.: 317 7-
State surcharge(12%of permit fee) g.-to
Authorized signature:// 4�,!tg d10
TOTAL PERMIT FEE
Print name: A/, • (IL t fl t'tp Date: "--I/..)/ This permit application expires if a permit is not obtained within I90 days
after It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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