Permit
n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2010-00022
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/15/2010
Parcel: 2S110DD03100
Jurisdiction: Tigard
Site address: 10530 SW CENTURY OAK DR
Subdivision: Lot: 0
Project: Christie
Project Description: Replace up to 100 feet of sanitary sewer line.
Owner: FEES
CHRISTIE, LORRAINE Quantity Description Date Amount
10530 SW CENTURY OAK DR
TIGARD, OR 97224 100 If Sewer Service 01/15/2010 $62.54
1 12% State Surcharge - 01/15/2010 $8.70
PHONE: Plumbing
10 ea Minimum Fee Adjustment - 01/15/2010 $9.96
Contractor: Plumbing
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503-239-8801
FAX: 503-669-9568
Type of Use: SF
Class of Work: ALT 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 952-001-0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Jan. 15. 2010 2: 51 PM No. 7501 P. 2/3
Plumbing Permit Application
RECEIVE
. Building Fixtures : . . .. FOR OFFICE USE ONLY
111 City of Tigard ! 1 5 [ 010 Received !� Permit No.:Rib2 -c0 depa.
v 13125 SW Hall Blvd., Tigard, OR 97223 P Review IP
■ . Phone: 503.639.4171 Fax: 503,598.19CITY OF TIGARD Date/By. Other Permit Na.:
TIGARD Inspection Line: 503.639 BUILDING DlVISIIN� ateReady /By: Sec Page 2 for
lntemet: www.tigard•or.gov Notified/Method: L Supplemental Informat
. TYPE OF WORK .: .. FEE* SCHEDULE _
❑ New construction ❑ Demolition For special Information use checklist.
-
Addition /alteration/replacement ❑ Other: New 2 -fam ells g (includes 100 fl. for each u iliry ection)
Description Qty.
\env ily dw 'n s in a con •
. . CATEGORY OF CONSTRUCTION .. SFR (I) bath 312.70
►: • and 2- family dwelling 0 Commercial/industrial SFR (2) bath 137,75
❑ Accessory building ❑ Multi- family SFR (3) both 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑Other. Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION •• Site utilities:
lob site address: 0 w C e•n }rte u 4 (/ 1) Catch basin or area drain 18.76
-►�! It! f]J Drywall, leach l or trench drain 18.76
City /State /ZIP: � 0- 1
- Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name:
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1 ' ( 1 ) 11 ( ) Rain drain connector 18.76
Sanitary sewer (no. linear R.: I Page 2
Storm sewer (no. linear R.: ) Page 2
•
Water service (no. linear fl.: i _) Page 2
Subdivision: I Lot no.:
Picture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORT{ : , .... ....
• Back valve 12.51
� � •
I/ � ``,, Clothes washer 25.02
"tr�-' 1 ( U V Dishwasher 25.02 •
64-- 11 S e LA Drinking fountain 25.02 -
Ejectors /sump 25.02
. • .:.:•. 1' nOPERTY OWNER .. - • . ....: ❑. TENANT....... Expansion tank 12,51
Fixture /sewer ca _ 25.02
Name: Lo Y Y J� _ _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
❑ APPLICANT
1:1 . .CONTACT PERSON • Interceptor/grease trap 25.02
Business name: Medical gas (value: S ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sinlubasin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 _
E-mail: 25.02
_Water closet 25.02
CONTRACTOR : . ►___
Water heater 37.52
Business name �1
"```^ :.1 c 1A 1 ) Water piping/DWV 56.29
Address: ;,Z 0 6 i , \ T , .Q �[ (] Olhcr: 25.02
City/ State /ZIPo,I(e. Navy( �� Y' �� � c� ci 1 030 Subtotal
Phone: (b3) 0 . 0 D 01 Fax: (t0I)6 (p 9 5W c Minimum permit fee: $72.50
CCB Lie.: c l Al 1 r Plumbing Lic no.• (o 5 0 p
Plan review (25% of permit fee)
1 State surcha (12% of permit fee)
Authorized ' nature: TOTAL PERNI1T FEE $)
IW I � Date. _ • I his perm(( appllcola bia permit is not obtained within days
after er it i expires
has beeen n accepted as complete.
"Fee methodology set by Tri•County Building Industry Service Hoard.
•
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