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Permit u v CITY OF TIGARD PLUMBING PERMIT, " ,2',',- COMMUNITY DEVELOPMENT Permit #: PLM2010 -00079 A Date Issued: 03/18/2010 41G A r), D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103DD00420 Jurisdiction: Tigard Site address: 10825 SW FAIRHAVEN WAY Subdivision: FAIRHAVEN COURT Lot: 13 Project: SampleNarnes Project Description: Relocate (2) w /c, (2) lays, and (2) tub /showers for (2) bath remodel. Owner: FEES SAMPLE, SUE ELLEN & VARNES, ALFRED Quantity Description Date Amount 10825 SW FAIRHAVEN WAY TIGARD, OR 97223 2 ea Lavatories 03/18/2010 $50.04 2 ea Tub /Shower /Shower Pan 03/18/2010 $25.02 PHONE: 2 ea Water Closet 03/18/2010 $50.04 1 12% State Surcharge - 03/18/2010 $15.01 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 $140.11 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: ` � , I a1 u , . (, Permittee Signature: 4,i9 Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 03 -18 -2010 12:01 3 MTNS PLUMBING 5039259104 PAGE1 Plumbing Permit Application 7 ( ,- "' I f n n Building Fixtures `4„ ll� III�r'Im I I .I /NIk ' -1 '' _n � r ' `.r�';�":. .� 1 g!�,ijn. i "4" sae �I'tYrt" �:S3+ , t� _-, ',� , r city of Tigard MAR 18 2013 Redveil Ptnasstl'to. � � Date/By: ... Pl 2U�o - oa 13125 SW Hall Blvd., Tigard. OR 977.23 Plan Review a" Phnne. 503,439,4171 Max; 503.59$ 1 t>vie y Other ,,r:cl ;az +/ i Inspection }.ins: 503.639.4175 ' ° i ` "I 9 I �= - - I I, it i) p r,;, Date Rcad -. ® See Vane 2 fvr " s.w,�:tv<...• Internet' www.tigard.ur.gov BUILDINGS DIMS. N ! C Sappicmacataltafirrawatiuu TYPE OF WORK FE ' • S(I:DU 1.11; • ❑ Ncw construction ❑ Demolition Fur special information use checklist: Description 1 Qty. I Ea. 1 Total J'Additiom /alteratiuir/replacement 0 Oilier: New 1- 2- family dwellings (includes 100 ft. for each utility connection) (A'TEGOKY OF CONSTRUCTION SFR (1) bath 249,20 . M and 2- family dwelling ❑ Commercial /industrial — SFR (2) Moth 350,00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399,00 ❑ Master bttildcr ❑Other. Each additional balhlkitchen 45.00 _ _ Fire sprinkler ( sq.11.) Page 2 JOA SITE 1■PORMA'nON ANT) LOCATION Site utilities _ Job site address: / r/ S J u j r `'] 02.1 Clay. Catch basin or arcs drain 16.60 y City/State/ZIP: tZIP: Q� €17742.2 3 �hwell, leach line, or trench drain 16.60 Suite/bidg. /apt. no.: I Project name: �q v /� Footing drain (no. linear R. _) Page 2 7 `! u Manufactured home utilities 110.00 Cross street/directions to joh site - - ' Manholes 16.60 _ Rain drain connector 1 6.60 Sanitary sewer (no. linear ft.: __J Page 2 Storm sewer (no. linear tt.: _) Page 2 Subdivision I Lot no.: Water service (no. linear ft.: _ Page 2 Fixture or item 'fax map /parcel no.: Absorption valve 16.60 _ DESCRIPTION OF W ORI ►3ackflow preventer Page 2 R €em ,./ ; T./c) cede Iwcf.hi Backwater valve 16.60 Clothes washer 16,40 _ Dishwasher 16.60 ❑ PROPERTY OWNF R I ❑ TENANT Drinking fountain 16.60 ... _.......r_ 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: () Fax: ( ) G arbage disposal — 16.60 E► APPLICANT Nose bib 16.60 ❑ CONI'ACl' PERSON Ice maker 16.60 Business name: Interceptor/grease trap 16.60 _ Contact name: Medical gas (value; $ ) Page 2 _ Address: — Primer 16.60 City/State/ZIP: Roof drain (commercial) 1 6.60 Sink/basin/lavatory p( "" /.: 760-01+ Phone: ( ) Fax: : ( ) ' � - 1 Tub /shower /shower pan 1:•r61 1 l � � - Ids.( E -mail Ni Urinal CONTRACTOR Water closet eR / % "' " ' 50.OLI Business name:3 i /n 5 p,/,,, , �i 1 W a fer heater � � _ 1 6.60 Address: PO ^ . x 30057 � ., r: _ Othc _ City/Statc/z1P: /7„,7,3/ Subtotal y T�Rj"�f ©� Minimum permit fee: $72.50 Phone: (5) 67.C, _ /3 (la Fax: ( ( ) .- 7/ay Residential back Row minimum permit fcc: $36.25 CCB 1.ic.: '6 Q'y99 Plumbing l .ic, nu.: p13 fy ... . . ..- flan review (25% of permit fee) J � " � - � orate surcharge (12% of permit fee) � ¢" Authorized signature: . TOTAL PERMIT FEE: f Print name: (i// 1 /, a r.. AI: 'rG , 7 eel Date: 310W/0 This permit application expires if a permit is not obta within - 1S0 days after 11 has been accepted as complete. *pee methndnlnpv set Iry Tri- Cnnnty Buil dim In,laclry .Crrvire Rnard 1I-1-'6 =[I 1)3; ( (OLVA, I(((t a V\