Permit •
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00351
T t G ARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 12/16/2009
Parcel: 2S112CA10400
Jurisdiction: Tigard
Site address: 7483 SW ASHFORD ST
Subdivision: RENAISSANCE WOODS Lot: 30
Project: Ouellette
Project Description: Replace 50' of water service. Electrical permit may be required if replacement pipe effects house
grounding.
Owner: FEES
OUELLETTE, KENNETH & JOANNA Quantity Description Date Amount
7483 SW ASHFORD ST
TIGARD, OR 97224 50 If Water Service 12/16/2009 $62.54
1 12% State Surcharge - 12/16/2009 $8.70
PHONE: Plumbing
10 ea Minimum Fee Adjustment - 12/16/2009 $9.96
Contractor: Plumbing
3 MOUNTAINS PLUMBING
20345 SW PACIFIC HWY SUITE 103
SHERWOOD, OR 97140
PHONE: 503 - 925 -1342
FAX: 503 - 925 -9104
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 Noti - •. i 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 di • questions to • NC b calling 503.246.6699 or 1.800.332.2344.
ssued By: Permittee Si. nature: •
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.
. .•.12 -1,5 -2009 16:11 3 MTNS PLUMBING 5039259104 PAGE1
Plumbing Permit Application
I r•
Building Fixtures �� '�� a n l r r" lr r I s : :) r � ' . t
:.o'", : C of Tigard iy.geBy iA � of Perm N o.: p �J,,
-" 13125 SW Hall Blvd.. Tigard, OR 97223 DEC 15 2009 —. -. � . 0055/ Plan Aeview
. D Ph one: 503.6.39.4171 Fax: 503.59K.1960 Other Permit No.:
t (.; k I) Inspection Line: 503.639.4175 CITY OF TIGARD rate Rowdy /lly: Avis ® See Page 2 for
Internet www.tigard- or.gov BUILDING =ISM : _- . Supplemental Information
TYPE OF WORK FEE* SCHF:11h1.F:.
[ 1 Q Demolition For speCsa(infnrmatlnn use checklist
.../PP... I)escnptum i 0 1 Ea, 1 Total
G Addition/altcration/replaccn 1 ❑ Other: New 1- 2 -famil
_ y dwellings ncludes 100 n fkw , each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
Ell- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building 0 Multi- family SFR (3) bath 399.00
Each additional bath/ kitchen 45.00
❑ Master builder ❑ Other:
_.,.. .. Fire sprinkler ( sq. tt.) Page 2
JOB SITE INFORMATION AND LOCATION Sitc utilities
Job Silt address: -- ?- Catch 4(V-; 52...„/ At --asP basin or area drain 16.60
City/Statc/ZIl': 77 9j ` -..../A (( Drywcll, leach line, nr trench drain 16.60 µ^
Suite/bldg. /apt. no.: Project name: Fouling drain (no. linear ft.: ) Page 2
Manufactured homc utilities 110.00
Cross SIredldireclinnS to jab site:
-
- Manholes 16.60
—
Rain drain connector 16.60
Sanitary sewer (no. linear it.: ) I'agc 2
—
Storm sewer (no. linear ft.: _J Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ,`i) Page 2 Wr
_..__..,. _ _ ....__...._ Fixture or item
Fax snap /parcel no.:
Absorption valve I6.60
DESCRLP'I ION OF WORK Backtlow prevcntcr Page 2
Backwater valve 16.60
-
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPI:R'FY OWNER ❑ TENANT _....... - .•
- Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/ floor sink/hub 16.60
-.
Phone: ( ) F ax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
- Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ _ ) Page 2
Address: Printer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
!'hone: ( ) I Fux:: ( ) Sink/haain/lavato y 16.6(1
'rub/shower/shower pan 16,60
f mail: Irrinal 16.60
CONTRACTOR Water closet 16.60
Business n 3 ev>' jt f Pit/r11 51 Water heater 16.60
Address: 40 3 die Sit/ 14- /`ftn- w/o, - Other
ckv
City/State /Z1P: 7�1a'lvY 0 Q 1�(f(� Subtotal
Minimum permil fee: $72.50
!'hone: ( ) vs -- /S Cj Fax: ( ) %1< y Residential huckfow minimum permit fa: $36,25
CCB Lic.: / y f f Plumbing Lic. no.: �,a of Plan review (25 %of permit fee) _ I 7C
Authorized signature: State surcharge (12% of permit fee) G �
TOTAL PERMIT FEE O / i
Print name: W t i 0 ,,,.. r jc- i Date: A2. -/( This permit application expires if a permit is not obtained within
180 days after it has been accepted Rs complete.
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