Permit 4 CITY OF TIGARD PLUMBING PERMIT
-- ' 13 COMMUNITY DEVELOPMENT Permit #: PLM2009-00349
;T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/10/2009
Parcel: 1S134CA00613
Jurisdiction: Tigard
Site address: 12055 SW MANZANITA CT
Subdivision: PANORAMA Lot: 12
Project: Bennett
Project Description: Replace up to 100' sanitary sewer.
Owner: FEES
BENNETT, DARIN Quantity Description Date Amount
12055 SW MANZANITA CT
TIGARD, OR 97223 100 If Sewer Service 12/10/2009 $62.54
PHONE: 503 1 12% State Surcharge - 12/10/2009 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 12/10/2009 $9.96
Contractor: Plumbing
JACK HOWK PLUMBING /RESCUE ROOTER
P.O. BOX 2830
CLACKAMAS, OR 97015
PHONE: 503 - 235 -8784
FAX: 503 - 491 -2932
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: y t n S�� n Permittee Signature: n ��
(J `(. Jam( Jl , lXJ .�-Q--C App
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
DEC -09- 2009 19:45 P.001
lalumbin Permit A licatio �EIVED
Building Fixtures ; � -� .. FOR*CiFF10E41.1 NI0NLW ti s ''• � ,r
C ity of Tigard a <cenw r-
I
. DEC 10 2009 (7aie,n� �� Permit Nn
4 131'_ 511 I tall Llh d . ['Tarsi, OR 97223
O
Phone jtl_ n �V 4 171 Fax 503 : �t$ Plan Ke�rca J
<4',+'p In- Tel:6011 Lute 503 t;; u 1('�
arty OF TIGARD ' Dat<•Bt Wier l' rma No
;1'1 GA:RD u,rc RvnJ It,
1mem l 14111 tigard- •ir •,r,� BUILDING DIVISION > ( 1� Sec
orm:Inuit
NiTiii d�(cthod !t em�
cntal : 'o
Inf
TYPE OF WORK I
FEE* S 4p1EDL LE
❑ New um tru<ti "lu 1:1 I)CI1U�hluul Fur f r ! i)rrnutiol aye (h' -�
_ J «Rli�r
Dean iron F:a. 1
Nen t- 2-
[ lddilirrn ,11teratiutv'replutrm ___
❑ Other p ' t 1 h ] I rtctl
h'.tmil} dw cuing; !includeti 101i 11 La unch ulihl■ uaihctlr nt
CATEGORY OF CONSTRUCTION sI:R11I )t'.711 — i
�I - and 3 Ftnnly dwelling f ummeruaIfin�Ju,tr;tl SI-It 12th,nh — -
L � Ji77t
❑ , >cces"rr` building [] Muth fantil� • I Shlt 131 bath can, 2
Each additional hash /hikhcn 25 ( 7
I _
I-- ❑ hlimer huilJer ❑ Other: er:
I Fire sprinkler 1 sq fl t Puee I
JOB SITE INFORMATION AND LOCATION S
Ste utilities:
tiv 1nh sac adJr�ss. �� 9 ! J ( l Tit. ' Latch hasin Ur area dram 18 7r,
— 1
City /State /ZIP' 776 /.. L
I` Urywell, tench line. urtrench drain 18.7h
wuingdrstln Ito, linear fie: I p ,
SuilGbldg „apt. no -: Project name: .. be _
AManufactured home utilities 50.I)3 —
CrtIss slret u'tlirt:elit,ns to job site: Manholes —`—
Rain dram connector Inn.76
Sanitary sewer (no. linear 11 : �6 Page 2 Ze•P,,
Sturm sewer ino. linear t1'.: ) i P age 2
--- - -... Water service (no. linear R: ) Page 2
Subdivision: Lot no.: Fixture or item: - ____ •
Fax map /parcel no.: - T B acktlnw preeenter 31.5 - -{
DESCRIPTION OP WORK backwater valve l , 51 1
� Clothes washer 25.02
/� /Lit / /� _ Dishwasher 25.02 —
�� Drinking fountain 25.0'
_ I- 1)cctors/sumpW 2502
PROPERTY OWNER 0 TENANT Expansion tank .1 2.51 -
v Future /sewer cap ,
Name: al.,• / r • / . i Jr i P z5.0
Audrey;; �j , • • Floor drain /(loursink/hub 25
—
/` O �r Garba disposal 5.0
• City /State /ZIP: / / �/�+ .
Hose bib 25.02
Phone: ( ,� .”- dr /.. ' Fax: ( ) lee maker 1).51
•
APPLICANT 0 CONTACT PERSON • httert eptor'grease trap - 25.02
Business name: ARS dba JACK HOWK /RESCLIE ROOTER Medical gas (value: 5 ) Page 2
Contact name: JOYCE DENNIS
Primcr 12,51
Roof drain (commercial) 12.51
Address: PO BOX 2830
-
Sink/basin/lavatory 25.02
City /State /ZIP: CLACKA 4AS, OR 9701.5 Solar units (potable water) 62.54
Phone: (503) 850 -3100 Fax: : (503) 491 -2932 Tub /showcrtshou•er pan 12.51
G mEtil: joyce(a�jackltnNk com Urinal 25.02
~
"' Water closet
• • • CONTRACTOR 23.02
Water heater 37.52
Business name: ARS dba JACK HOWK/RESCUE ROOTER water pipin�DWV 36.29
Address: PO BOX 2830 Other: 25.02
City /State /Z1l': CL.ACKAMAS, OR 97015 Subtotal C w
Phone: (503) 850 -3100 Fax: (503) 491 -2932 Minimum permit fee, 572.50 .
CCB Lic.: 127325 "gibing Lie- no.: 34 Plan review (25 %ofpermit fee)
, /� �,,� /� State surcharge (12% of permit fee)
`
Authorized signature: L r (,/(, TOTAL PERMIT F d •
Print name: / CI r ".��� Dat r / , i This permit anon tied expires if a permit ix not obtained in !'y r
niter It has been accepted as complete;
— *Feo me to bl pgrsetty . Tri•Cotinty Building Industry Service hoard,
1 lawlding %Permhs1eLsiu- PcrmitApp.due loimio Please FAX PERMIT COP • - \ 1