Permit t `' CITY OF TIGARD
PLUMBING PERMIT
` t o s:: COMMUNITY DEVELOPMENT Permit #: PLM2010 -00076
T I G A R Q 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/17/2010
Parcel: 2S103AA04300
Jurisdiction: Tigard
Site address: 12237 SW CLYDESDALE CT
Subdivision: Lot: 0
Project: Dunn
Project Description: Replace up to 100 feet water service.
Owner: FEES
DUNN, STEPHEN W AND Quantity Description Date Amount
HALPERN, MICHAEL L, 29572 AVANTE
LAGUNA NIGUEL, CA 92677 100 If Water Service 03/17/2010 $62.54
1 12% State Surcharge - 03/17/2010 $8.70
PHONE: Plumbing
10 ea Minimum Fee Adjustment - 03/17/2010 $9.96
Contractor: Plumbing
NORTH'S PLUMBING
17120 SW SHAW
BEAVERTON, OR 97007
PHONE: 503 - 649 -5544
FAX: 503 - 649 -8605
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: (� /
US 2 V' ). ay Q Q I Permittee Signature: n
r uL U2 ( J X ,p
Cali 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM :Norths +FSC FAX NO. :5036498605 Mar. 16 2010 05:40AM P2
• Plumbing Permit Appli li on ; , E D
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Site tltilitie$ 11 ' °' a ► OR il l i ►(�I 1'1SIAONr4) f }s ,
MAR 1 ®20 13 v � 3 _ �l x l.. t- Ai ate `
� City of Tigard P«mit No,: I � £ �j ! i (A:0• �...
* u 13125 SW Hall Blvd., Tigard, 11 912n - 1 I (3 rQrl _ Oiler Permit No.:
i " 1 - Plan Review
,.. m Phone: 503.639.4171 Fax: R3.• 98.1060 B
Wit• <�; Inspection Line: 503.639.417301- DIVISION Datc
E � �, ) 0Mb Dxtc Rexdy /Ry : [d See Page 2 for
fii Oa� IntInternet; www.tigard -or.gov Natified /Method: 1 1 ( s [ Supplemental Information
t';n I '"I d,t RU. A' (H•V,. ' r ' 1.; ' _ i°� ' , i . g.'4xl V .'� `F'I " 1 i rtw LI �'�.,K� �j 4i j ' ( `d I �l fie od r - ,; l h so I �I 1 ., r . 3 ,!^ ;i ' ' r ' 1
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❑ Ncw construction 0 Demolition For spedal l (ormadon use checklist
--- ---- -- •--' Descri Qiy. Ea. ( Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
1„ "msv�il ' 15111.4 " .113 r '* pawn ' AM "s�' s�'r nW ulmh r11+8 i 1 ,m ' ∎m o- - FR(I)bath 31170
., k a+l' .1 l iOK w = ,' (.. eh "'µ i? ',, � 01,1i.x u ,,., I ". ` r...r!i .�....�........_.-
ra 1- and 2-family dwelling 0 Commercial /industrial SFR (2) bath 437.78 -_
SFR (3) bath 500.32
0 Accessory building 0 Multi - family
_.. Each additional bath/kitchen 25.02
❑ Master builder 0 Other:
�� ,,�� Fire sprinkler (_ sq. ft.) Page 2
� t '' ! . r ? m r � .; a ten ..,, li % I , w:: �It(il 1s�„ a ; k. Site "Imes.
situ address: 12237 SW Clydesdale Court Catch basin or area drain 18.76
--- Drywell, leach line, or trench drain 18.76
City / State/ZIP: Tigard, Or 97223 --
_.._, ,_. _._� -- Footing drain (nu. linear ft.: „�) Page 2
Suite/bldg. /apt. no P name: U 0)3 Manufactured home utilities 50.03
Cross street/dircctitms to job site Manholes - 18.76
Rain drain connector 18.76
. - Sanitary sewer (no. linear ft.; ) Page 2
- - Storm sewer (no. linear ft,; _) Page 2
Water service (nu. linear ft.: ) Page 2 62.54
Subdivision: I Winn.: Fixture or item:
Tax map /parcel no.; l3at kflow preventer 31.27
� trEl'Ia'! . t 1 ' �1'i v i i `x � 'rll! (fir i ,,,, r • ,, amkwater valve 12.51
l��d�. !Yll�l�..i't�tdn;�:7. 6� 9 j a� '. �lf�m,,'i':1� l a, .lh,lf h,1,. ' 11!;'} cl othes washer IEMI
Water service repiaement Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
LEA! r,3 5, ' ,: SsPlr`jiwi�tl'I;' y� nI N 1 � g�" E p asintank
12 51
t �. . ;d . r �, II, t... ,,,, , i' 14 , ti , t, . -,._
` '
Fixture/sewer cap 25.02
Name:
.. Floor drain /floor sink/hub 25.02
Address: - Garbage disposal 25.02
City /State/ZIP: _ 'lose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12,51
��PEI r ¢ • a , ' > v i ..,1q=4132.,=, a , ).i4, , interceptor/ trap 25.02
,v . ,1�� " i s,� 'frr* w ,'PJ G I : a 11.tl -� "a
Business Hama: Medical gas (value: $ - ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) ( Fax :: ( ) Tub /shower /shower pan 12.51
-
E mall Urinal 25.02
�( �Q IWI ► n I a3 t4[i 1 o- ,1itl' d c . V o- i .4i ,l] t;i Water closet 25.02
I dt t rr6l A al i �a. ' F ' , ! i � i \,f la .I ; . 4Ii∎I f l , � { I • Water heater 37.52
Business nine: Norths Plumbing Inc Water piping/DWV 56.29
Address: 3960 SW 173 AVe Other: 25.02
City / State/ZIP: Beaverton Or 97007 Subtotal
Phone: (503) 649 -5544 03) 649 -8605 - N Minimum permit fee: $72.50 72.50
- i Plan review (25% of permit fee)
t CO3 Lie.: 340 11W � , tubing Lic. no,: 34 State surcharge (12% of permit fcc) 8.70 -
Authorized signature: �� r ! � '/.' - , j / , . TOTAL PERMIT FEE 81.20 - D ate: 03 /15 /Z010 This permit application expires if a permit is not obtained within 180 days
Print name: Darlene Butcher after It has been accepted as complete.
- - "Fee methodology set by Tri- County Building Industry Service Hoard.
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