Permit
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit PLM2010-00055
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/23/2010
Parcel: 2S102BC02004
Jurisdiction: Tigard
Site address: 10680 SW FONNER ST
Subdivision: Lot: 0
Project: Carmichael
Project Description: Replace 50' of water service. NOTE: ELECTRICAL PERMIT MAY BE REQUIRED IF
REPLACEMENT PIPING EFFECTS HOUSE GROUNDING.
Owner: FEES
CARMICHAEL, LINDA & JOSEPH Quantity Description Date Amount
10680 SW FONNER ST
TIGARD, OR 97223 50 If Water Service 02/23/2010 $62.54
PHONE: 503-670-7004 1 12% State Surcharge - 02/23/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 02/23/2010 $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 Notif ien-Geri Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
or dir questions to OUN calling 503.246.6699 or 1.800.332.2344.
Is ed By: Permittee Sig ture:
Call 503.639.4175 by 7:00 a.m. for an inspection that busi ess 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.
:.Feb. 23. 2010 11:33AVI No, 8321 N.
Plumbing Permit A liea -ion, p
Building Fixtures „ ek 1~r r``f .4 ~ t.
4a+ RCCeiti~ed
ab Cif of Tip (I [[[[pp 2 Pemiil No.:
a3 ~Q
` v 13125 SW Hal Blvd.. Tigard, OR 99223D 2 3 2010 P1ml Reti11a I'Miew
d Phone: 503,639,1171 Fax; 503.598.1960 Omer Permit No.:
D„e,~
r y: IllsPCCIIUII I-ir1C: 503.G39A 175 CITY OF i E UARD Dale EZeadyll9y; luris M See Pace ]for
InlCmet: K1sM1Y.tignrd-Or.gOV i fiai~~ (`)I ~`j~~ NotifreslRs9ethod: Supplememallnforroatlon
nee, SCIICUUI,E
TYPE OF WORK
❑ New construction ❑ Demolition Fors reclal Lr orrnrrrlon rise checklist.
Description Q(. L'A. Total
ditiotllnllerntiotl/replacelnenl ❑ Olhcr; New I- 2-family d~velliugs (includes 100 fl. for each Milk connection)
CATEGORY OF.CONSTRUCTION SFCt(1)balh 312.70
nd 2-family dwelling El Commercial/industrial SFR (2) bmh 437.78
SPR (3) bath 500.32
❑ Accessory building ❑ Multi-family Eneh additional bath/kitchea 25.02
❑ Master builder ❑ Other; Fire sprinkler ( sq. ft.) rage 2
Site utilities:
ran SITE INFORMATION AND. LOCjVr1ON
Sob site address: Catch basin or area drnin 18.76
Orywell, leach line, or trench drain 18.76 r V1 V1 _12- C City/Stale/Lll': Q C) Z; Footing drnin (no. linear ft.: Page 2
Suite/bldg./apt. no.: Project name; Mnnafaclured home utilities 50.03
Cross streedrlirections to job site: - Manholes 18,76
Rain drain connector 18,76
Sanitary sewer (no. lincor ll.: ) Pnge 2
Storm sower (no, linear n.: PAge 2
Walcr service (no. linear ft.: W) Page 2
Subdivision: Lot no,; Fixture or item;
Tax map/parcel no.: Hackflow proven ter 31.27
Backwater valve 1251
DESCRIPTION QF,ti1'OIiK
t Clothes washer 25.02
Dishwasher 25.02
Drinking fOlllllalll 25.02
Ejectors/sump 25.02
OPERTY OWNER ❑ TENA T.. Expansion tank 12.51
Name: Fixture/sewer cap 25,02
Floor draitt/floor sink/lttlb 25,02
Address:
Garbage disposal 25,02
City/Stale/ZIP: Hose bib 25.02
Phone: ( 7 fa>;: ( Ice maker 12-51
PLICANT El CONTACT POSON hucrccptodgrcasc trap 25,02
Business name: Medical 885 (value: S ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basinflavnlofy 25.02
City/State/Z1P: Solar units (potable water) 62.54
Phone; ( ) Fax:: ( ) Tub/shown/shower pan 12.51
E-mail: Urinal 25.02
- - ° Water closet 25.02
CONTRACTOR
Wnlcr healer 37.52
Business nam WalDr pipinE/DWV 56.29
Address: Other: 25.02
Clly/SIatC/Z1P; 7 $ub101A1
Phone: ( Fax: (
_0 Miainmm permit fee: $72,50 5f3 19 CCB Lie.-. ]'lambing tic, nn • J~J Plan YCVICw (25°0 of permit Itd)
Sinte surcharge (12% of pennit fee)
Aulhori2ed signatu TOTAL P00011' FEE
This permit applicatlou expires if a permit is not ebialned iislthln 180 days ILL 7E after it has been accepted as complete.
Prins name: • ( Dale:
'Fee methodology set by 7'si-Cosmry Building Industry Service Board.
1:1Duildi%Termits~Pl,bfU•Permirnpp,doc 10101109 440--JM6T(iWD21C0MfWQ!)
-, „ zx��,�, CITY OF TIGARD PLUMBING PERMIT
i
,1 a
ip
° ;; COMMUNITY DEVELOPMENT Permit #: PLM2010 00055
:Ti AA 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/23/2010
Parcel: 2S102BCO2004
Jurisdiction: Tigard
Site address: 10680 SW FONNER ST
Subdivision: Lot: 0
Project: Carmichael
Project Description: Replace 50' of water service. NOTE: ELECTRICAL PERMIT MAY BE REQUIRED IF
REPLACEMENT PIPING EFFECTS HOUSE GROUNDING.
Owner: FEES
CARMICHAEL, LINDA & JOSEPH Quantity Description Date Amount
10680 SW FONNER ST
TIGARD, OR 97223 50 If Water Service 02/23/2010 $62.54
1 12% State Surcharge - 02/23/2010 $8.70
PHONE: 503 - 670 -7004 Plumbing
10 ea Minimum Fee Adjustment - 02/23/2010 $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 Notif . - • . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir- • questions to OUN calling 503.246.6699 or 1.800.332.2344.
Is ed By: // ' I Permittee Sig : ture: ��i
.�. < <� L� ..ma � 7i�r o
Call 503.639.4175 by 7:00 a.m. for an inspection that busi ess 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.
-Feb, 23. 2010 11:33AM No. 8321 P. 1
Plumbing Permit Application, F r
Building Fixtures ' ,,, , `" %'
: ., City of Tigard Received
[[ p �/b •�
4,, i 6 ' y 13125 SW Hall Blvd., Tigard, OR 9-?zEB ` 2 3 2010 Dele/13y: ,1 ,..0 1 r e• l
Plan Review
11 - d . • Phone: 503.639.4171 Fax: 503.598.1960 D 11e /BY: Other Permit No.:
4'0 lnspeelion Lute: 503.639.4175 CITY OF y IGARD Date Readylay: ,uris: See Page 2 for
g a Internet: www.tign � rd- or.gov n f! ! , f! l!SI(11�j Notified/Method: Supplemental Information
.,.. TYPE OF • WORK • FEE* SCI1.IDULE
❑ New construction ❑ Demolition For speedo! lufon use checklist.
T Description 1 Qty. 1 Ea. 1 Total
P w dition lollerntion/replaceinent ❑ Other: New 1- 2- fnmlly dwellings (includes 10011. for each ulility connection)
• CATEGORY OF CONSTRUCTION SFR (I) bash 312.70
', nd 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SP1t (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25,02
❑ Master builder ❑ Oilier: Fire sprinkler ( sq. 11.) Page 2
JOB SITE INFORMATION AND. LOCA'1 Sine utilities:
♦ 1 Catch basin or area drnin 18.76
Job site address: D , M -� . �..,
Drywall, Ieach line, or trench drain 1 8.76
City /Stale /ZIP: arid= dr,1 ac.. i. • Z",� Fooling drain (no. linear fl.: ) Page 2
Suitc/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: - Manholes 18.76
•
Rain gain connector 18,76
Sanitary sewer (no. linear (1,: ) Page 2 V _
Storm sewer (no. linear 11.; _) Page 2
Water service (no. linear ft.: ( Page 2
Subdivision: 1-01 no.: Fixture nr item;
Tax map /parcel no.: Rncldlow prevenler 31.27
I3nokwater valve 1251
DESCRIPTION' OF . WORK ...
1 r
Clot washer 25.02
I ,Ail/ .� IL. i / ..t Dishwasher 25.02
T i
r Nimil Drinking fountain 25.02
Ejectors /sump 25.02
f' OPERTY OWNER ❑ TF,NA� T Expansion tank 12.51
Fixture /sewer cap 25,02
'�j r -`� -"' . Id/ , _. / �. - Floor drain/floor sink/hub 25,02
Address:
Garbage disposal 25,02
•City /Slate /ZIP: e Hose bib 25.02
Phone: ( . 7 • ro Fax: ( ) Ice maker 12.51
- Ki PLICANT . .0 'CONTACT PERSON Interceptor /grease trap 25,02
Business name: A 4 . 41 , ` 1� Medical gas (value: $ ) Page 2 .
� Printer 12.51
Contact name: `N Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /Z1P: Solar units (potable water) 62,51
Phone: ( ) - I Fax:: ( ) L Tub /shower /shower pan 12.51
E-mail: Urinal 25.02
• Water closet 25.02
CONTRACTOR . • . : • ._,
� Water heater 37.52
Business 110111 � I J A
4 i f►Il%f -� Water pipinp/DWV 56.29 _ Address: , V , �/ Othe w 25.02
City /Slate /ZIP: ad / J j ,t ' 71W. w w-- . Subtotal
f 0 / /: Mininuun permit fee: $72.50
Phone: ( .11/ J � e Fax: ( 1 Plan review (25% of permit fee)
■ice Plumbing tic no
t1� � State surcharge (12% of permit fee)
Aulhori2ed Signatu - / • TOTAL PE11.1vlll' FEE
V ,� Dale: ,r This permit application erplres If a permit Is not obtained within 180 days
/1
diet it has been nccepled as complete.
•Fee methodology sal by Tri- CoLnny Building Industry Service Board
I;\ IIuilding \Permils\PI.MU.PermilApp.doc 10 /01/09 .1a0- 4616T(10/02 /COMM'en)