Permit 1
.01 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00441
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/04/2019
Parcel: 2S 110AC01300
Jurisdiction: Tigard
Site address: 11430 SW BULL MOUNTAIN RD
Project: Bull Mountain Heights Subdivision: None Lot: None
Project Description: Replace double check and pressure regulating valve.
Contractor: ANYTIME PLUMBING & DRAIN CLEANING Owner: PATHFINDER TIGARD HOLDINGS LLC
PO BOX 495 4380 LA JOLLA VILLAGE DR STE 250
LAKE OSWEGO, OR 97034 SAN DIEGO, CA 92122
PHONE: 503-894-8241 PHONE:
FAX: 971-255-1965
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/04/2019 $31.27
Specifics: 25 Misc Other Fee 11/04/2019 $25.02
1 12%State Surcharge- 11/04/2019 $8.70
Type of Use: MF Plumbing
Class of Work: ALT 16 ea Minimum Fee Adjustment- 11/04/2019 $16.21
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: &c.. 572/4,ze 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.
Plumbing Permit Application •
Building Fixtures ECEIV L FOR OFFICE USE ONLY
III City of Tigard
Received4/0f /�/
PermitN L� ell- ??Cl`17/
_ • 13125 SW Hall Blvd.,Tigard,OR 97223 N O V 4 2O 1 L PianDatc/By:e Rnew
Phone: 503.718.2439 Fax: 503.598.1960 Dat JBy. Other Permit No.:
Inspection Line: 503.639.4175 a
TtcAlzn CITY OF TlGA_ to Ready/By: Juris• 0 See Page 2 for
Internet: www.tigard-or.gov
U1 C�1NG D ificd Method: Supplemental Information
BUILDING ' .
TYPE OF WORK , ;', FEE* SCHEDULE
■ New construction 0 Demolition For special information use checklist
Description I Qty. [ Ea. I Total
1 ■ New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building Multi-family - mm
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORtMATION AND LOCATION Site utilities:
Job site address: i04170 f lit t, , V / , 6 Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1-1 Ll A 0 Page k J Footing drain(no.linear ft.: ) Page 2
Suite./bldg./apt.no.: Project name: 0(A ryl(1Uilt 'r11 AL 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer I 31.27 221,,��
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer e 25.02
l i to i 4 t>0 IA{ "fi . ( t - 4- , (� 1ii�!111111 Dishwasher 25.02
Y?L✓I) ,. I ii (p /0/7-., fefit, / Uv'.-T7/J Drinking fountain 25.02
V4--I' Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
_
Name: lik.u. l Y l 01A Ntrill 1t6 0 -C Fixture/sewer cap 25.02
WA-- } Floor drain/floor sink/hub 25.02
Address: i 1 r`.7yb .c G i,t 1 N
V / Vt� Garbage disposal 25.02
City/State/ZIP: 'f i��r l K ---/ 0 1` t- Hose bib 25.02
Phone:( 72) 4 pj1 0 1 n\s, Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: A'I�l l i joiur/�o i m4 ( Medical gas(value:$ ) Page 2
Y; Primer 12.51
Contact name: Ac "�'-j ( ill I ei2
�L Roof drain(commercial) 12.51
Address: eVp ' D X r-t vt S Sink/basin/lavatory 25.02
City/State/ZIP: L 'Ve aS F .t ►c_ /10 -1 Solar units(potable water) 62.54 -
Phone:( ) (IC,, g•2,L}-( p A �''Fax::(d'fl ) /.'c'S-- f (p S Tub/shower/shower pan 12.51
E-mail: Vkcyl l tiA QJ ki L�►mt.e. l iA'y1 ° u.s Urinal 25.02
Water closet 25.02
ONTRACTOR
Water heater 37.52
Business name: 1Vi---` V 6 P g(W(ji Water piping/DWV 56.29
Address: / f t A / K Other: ,Q-.\f !j
'25.02 c,o 2
City/State/ZIP: L4 VF 0S f1b / D1 1.-1(,) ' �
Subtotal _�f71_
Phone:(J()")) ic A t.� , 'Zt-/ 1 "l Fax:(ell 1 )`_SS. j4.ig S" Minimum permit fee: S72.50 1/.St
CCB Lie.: 1 1 11_ Plumbing Lic.no.: (.2( goi t.f Plan review (25%of permit fee)
State surcharge(12°-i,of permit fee) ',10
Authorized signature: G :/ �,f� TOTAL PERMIT FEE g 1,'z,0
1 /4j 11
Print name: /� C}.� ( l f� Date: 1 iThis permit application expires if a permitp is not obtainedp within 180 days
vlr r 1 t J after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:Building'Permits`PLMU.PcrmitApp.doe 10,'01'09 440-4616T(10/02'COM/WEI3)