Permit
CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit#: PLM2010-00029
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/22/2010
Parcel: 2S111 DB11900
Jurisdiction: Tigard
Site address: 15215 SW 94TH AVE
Subdivision: SUMMERFIELD NO.12 Lot: 646
Project: JONES
Project Description: Replace up to 100 feet of water service.
Owner: FEES
JONES, RICHARD NEWTON JR Quantity Description Date Amount
15215 SW 94TH AVE
TIGARD, OR 97224 100 If Water Service 01/22/2010 $62.54
PHONE: 1 12% State Surcharge - 01/22/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 01/22/2010 $9.96
Contractor: Plumbing
KELSO CONSTRUCTION
5750 HWY 35 MT HOOD
PARKDALE, OR 97041
PHONE: 541-806-1835
FAX:
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: r-~4 n QA-A
1,64
Call 503.639.4175 by 7:00 a.m. for an inspection that busin ss 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.
Plumbing Permit Application
® FOR OFFICE USE ONLY
Site Utilities
RECHVE7_7
City of Tigard Received permit No..
e 13125 SW Hall Blvd., Tigard, OR 97223 JAN 21 .Z01 O Plan Re : 2Q
Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: B See Paget for
Internet: www.tigazd-or.gov NotifiedlMethod: Supplemental Information
TYPE OF WO EDING
FEE* SCHEDULE
❑ New construction ❑ Demolition For s ecial information use checklist
Descti 'on Ea. Total
Addition/alteration/replacement ❑ Other: New I- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ i-and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ 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: Z S ?H tie Catch basin or area drain 18.76
City/State/ZIP: Drywell, leach line, or trench drain 18.76
(Od r`' ?'2- 2 t ` 5 6 7 Footing drain (no. linear ft.: Page 2
Suite/bldg./apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Idez,6 r 1jife 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 2 .qtr
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION,OF WORK Backwater valve 12.51
Clothes washer 25.02
11'p 'az d e ~rlCl~ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER, ❑ 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
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
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: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: ys Water piping/DW V 56.29
Address: Jam. J5 W ~15 T 14 Q p Other: 25.02
City/State/ZIP: MAONV- ( Ag+ -7 0A1 Subtotal
Phone: Q 6 P 3 b Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: O Y/ 7 Plumbin$,Lie. no.: , 41 Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature:. TOTAL PERMIT FEE
Print name: Date: This permit application expires if a permit is not obtained within 180 days
L~ 0 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board