Permit f q CITY OF TIGARD PLUMBING PERMIT
,. '91' a COMMUNITY DEVELOPMENT Permit ii: PLM2010 00037
TIG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/02/2010
Parcel: 25111 CC04000
Jurisdiction: Tigard
Site address: 15990 SW CENTURY OAK CIR
Subdivision: Lot: 0
Project:
Project Description: Replace up to 100 feet of water service, and water line to (1) clothes washer, (1) dishwasher,
(1garbage disposal, (2) hose bibbs, (2) lays, (2) tub /showers, and (2) water closets.
Owner: FEES
THOMSON, NOREEN KAY TRUSTEE Quantity Description Date Amount
15990 SW CENTURY OAK CIRCLE
TIGARD, OR 97224 100 If Water Service 02/02/2010 $62.54
1 12% State Surcharge - 02/02/2010 $14.26
PHONE: Plumbing
1 ea Water Piping 02/02/2010 $56.29
Contractor:
CASEYS PLUMBING INC
P.O. BOX 30075
PORTLAND, OR 97294
PHONE: 503 - 253 -0030
FAX: 503- 262 -8251
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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. At 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: -_ - ' , ! I (�` ♦ P Signature: 4 ^ S[ _ ► •
_ 1
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 29 10 05:49p Casey's Plumbing 5032828251 p.2
Plumbin Permit A lication r
. I i P '� ,. e. �w X l F.
Building Fixtures CEIVE -^ j + , , tC -E VWZI ' '.: +'
., City of Tigard JAN 2 9 2010 Received _ permit No.:P �'D -�O IL tt, 13125 SW Hall Blvd., Tigard, OR 97223 Daiemy' - w
;!,u. ('hone: 503.639.4171 Fax: 503.598.1960
Plan t y Other Permit No.:
!±rte . Inspection Line: 503.639.4175 CITY OF TIGA n : See Pa e ental 2 for
} Dale RcadyBy: S
;;e±tyier,�tmei hInternet www.tigard- or.gov Buie DING DIVISION Notified /Method: Supplemformatina
TYPE OF WORK FEE* SCHEDULE
❑ 'ew construction ❑ Demolition Forsprcial information us c/re
Description 1 Qt j Ea. I Total
ddition/altcration/replaccment ❑ Other: New 1- 2- family dwellings (includes 100 It. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
-a nd 2- family dwelling ❑Commercial /indu:: ;trial SFR (2) bath 437.78
(((((( SFR (3) bath 500.32
❑ Accessory building ❑ Multi - fancily
Each additional bath/kitchen 25.02
❑ Master builder _ I ❑ Other: Fire sprinkler ( sq. lt.) Page 2
JOI3 SITE INFORMATION AND LOCATION Site utilities:
• Job site address: S-c G cev (0�k ` J Catch basin or area drain 18,76
) SIIJ � t , '� ( Drywcll, leach line, or trench drain 18.76
City/State/Z11': �7 , 1 - - -- "- -
y �(t t;"r Ct� ' C E 1 Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt. no.: J Project nave: Manufactured home utilities S0.03
Cross street/directions to job site: ' • Manholes 18.76
Ram drain connector 18.76
Sanitary sewer (no. Linear ft.: _) Page 2
Storm sewer (no. linear It.: ) Pagc 2
Water service (no. linear ft.: SC.) 0) 1 Page 2 (O
AN
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer K 25.02
`�.- -\- G"C\A 1 -t -e r %. Y l)(C Q_ Dishwasher
/ 25.02
Drinking fountain /' 25.02
Ejcctorslsump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixtureisewer cap 25.1)2
Name
,` C m , �` Floor drain /floor sinkAmb 25.02
Address: 9 0 � .-e t\'kyr �. C,..c
----Vi r � Garbage disposal X 25.02.
City /State /ZIP: t a - s Hose bib 25,02
17
Phone: ( ( (�) .8(4 _ l e) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: �(r� M�1 ivy v,
'� Medical as (value: $ ) Page 2
-- - - -- Cl� 5 \Jl
Primer 12.51
Contact name: ';Z !. CA . C -- - --
�-�'� � Roof drain (commercial) 12.51
Address: () I. �C)� - Imo Sink/basin/lavatory 25.02
City /State /ZIP: ?(-. rt a t L Q t�•'1 2(.. Solar units (potable water) 62.54
Phone: (' 0` -_(Ci Fax: : () a tna .3 Tub /shower /showcrpan 12.51
E Urinal 25.02
Email:
- _.�t'Cl ( _CCt C' c C A..∎ - •c\\ �Y^ ( t'fyTh Water closet 25.02
CONTRACTOR -
Water heater
.1,' 37.52 t375D
Business name: -
i/ .. J1 A i l L Water piping/DWV 56,29
Address: U.. ,.C� S Other: 25.02
City /State/ZIP: i C1-A,rt 1`1 t i ` ci`1 2_94-4 Subtotal
Phone: (5 ,- 1 as _ _ ciU c_ Fax: (5(12)) Q 1p-.)_(i.1„. \ Minimum permit fee: $72.50
CCB Lic.: ) LA1 r�l cis Plumbing Lic. no.: Q4, -p , R)
Plan review (25% of permit fee)
State surcharge (12% or permit fee)
Authorized signaturc:( n a
tt c Le p i:_f } TOTAL PERMIT FEE
Print name: ,, This permi application expires if a permit is not obtained withr 8 days
IVi ' �� �Ilcff D ate: J - Y
after it has been accepted as complete.
•Fee methodology set by '16-County Building Industry Service Board.
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