Permit CITY OF TIGARD PLUMBING PERMIT
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', COMMUNITY DEVELOPMENT Permit #: PLM2010 00039
T t AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/03/2010
Parcel: 1S134CA04100
Jurisdiction: Tigard
Site address: 11650 SW NORTH DAKOTA ST
Subdivision: Lot: 0
Project: Walker
Project Description: Install /replace (2) lays, (1) tub /shower, and (1) w /c.
Owner: FEES
WALKER, THOMAS A JR & JENA A Quantity Description Date Amount
11650 SW NORTH DAKOTA ST
TIGARD, OR 97223 2 ea Lavatories 02/03/2010 $50.04
1 ea Tub /Shower /Shower Pan 02/03/2010 $12.51
PHONE: 1 ea Water Closet 02/03/2010 $25.02
1 12% State Surcharge - 02/03/2010 $10.51
Contractor: Plumbing
CANBY PLUMBING
805 NE 4TH AVE
CANBY, OR 97013
PHONE: 503 - 266 -2091
FAX: 503 - 266 -1424
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $98.08
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: _ —'-h • - ` f i t i C . Permittee Signature: J p
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.
01/28/2010 21:19 5032661424 CANBY PLUMBING PAGE 01
RECEIVE .� 5k-r (ll t)I.f Itwl i til tl�h 1 r r
Plumbing Permit Applicatio w: ti N
,: citySWTigard Z0i0 PcrmIt p � � ��•
' '>a 13125 SW Ha Blvd., Tigard, OR 972 Ja N 2 9 -
Ptan Rcv Otber Permit No.:
1( 0 Phone: 501639.4171 Fax; 503.598.1960 p,icniy:
ir inspection Linc: 503.639.4175 CITY OF TIGARD pate Romty/By: FIN El Sc e Page z far
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f3RS�'.ia� Internet: vvww,tigani- nr.gov : ' , - fcd/MMh ! SuDDkmrntnl Information
TYPE OF WORK _ k / � � Noti
FEE'S SCR -OULE
E] New construction ❑ Demolition
r�cscn.tion For eeralI armalionusecheckliss�
Total
❑ Addition /alteration /replacement ❑ Other: Ncw 1- 2- family dwellings (includes 100 ft, for each utility connection)
CATEGORY OF CONST1U1CTlON SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional hath /kitchen 45.00
❑ Master builder Q Other: V _ Fire sprinkler ( sq. ft,) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities _ -
.Toh site address: N { , s , Ca tch basin or arca drain 16.60
� 1 �.P U�� 111 1 t Qf!� Q C�Lk
City/State/ZIP: . J�^ •. 5 17rywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: vied. namc:
Footing drain (no, linear R.: _ ) Page 2
Manufactured home utilities 1 10.00
Cross 9t rcct/directions to job site:
Manholes 16.60
- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: � ) Page 7-
Storm sewer (nn. linear ft.: ) Page 2
Subdivision; I Lot nn,: Water service (no. linear ft,: ) Page 2
Fixture or item
Tax map /parecl no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventcr Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER ❑ TENANT
Ejectors/sump 16,60
Name: "t' I a 4 X" W +' J Fxpanaion tank 1 6.60
Address: y \ (', t vvv "`111 ( c�}�� . -�l �S7- F . Fixture /sewer can -M 16.60
City/State/ZIP: 1 riJ , 04 1 2,175 - 3 ._ Floor drain /floor sink /huh 16.60
Phone: kV. * al, Fax: (rte �1 O Garbage disposal .� 16.60
• - ` A Huse bib 16.60
0 APPLICANT ❑. CONTACT PERSON
lee maker 1 6.60
Business name: interceptor/grease trap 16.60
Contact name: Medical gas (value; $ _ .. ) Pape 2
Address: Primer 16,60
City /Statc/ZTP: Roof drain (commercial) 16.60
Sink/basin/lavatory 7- 16.60
Phone: ( ) Fax: ( ) Tub /shower /shower pan / 16.60
E-mail: Urinal 16.60
CONTRACTOR + Water closet - I 16.60
Business namc: J ` \ • 1 p Water heater 16.60
Address: - 0 � F LIA-1_- Other:
city/Slate/ZIP: n C1.10 9abtntal
Cit /Slate /
t Q 1 t ..
Minimum permit fcc: 472.50
Phone: `J Jam. L " ALp - ' q i Fax: 7) ZA4p,{,p. /L 2 4, Residential backflow minimum permit fee: $36.25
CCB Lie 3 5'y) lumbin Lk. no.: ,,`7 ip Plan review (25% of permit fcc)
� State surcharge (12 ".'0 of permit fee)
Authorized signature r. 'rQ'I'AL PERMIT FEE
Print Warne: i. S DatejAN 2 9 IU1U This permit application expires If a permit is not obtained within
180 days after it has been accepted as complete,
"Fcc methodology set by Tri County Building Industry Service Board.