Permit {r n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00110
TI GARD: 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/07/2010
Parcel: 2S114BA13000
Jurisdiction: Tigard
Site address: 16475 SW COPPER CREEK DR
Subdivision: COPPER CREEK NO. 3 Lot: 95
Project: Mainlander Property Management
Project Description: Replace up to 100 feet water service.
Owner: FEES
MAINLANDER PROPERTY MANAGEMENT Quantity Description Date Amount
3927 SW LAKE GROVE BLVD
LAKE OSWEGO, OR 97035 100 If Water Service 04/07/2010 $62.54
PHONE: 1 12% State Surcharge - 04/07/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 04/07/2010 $9.96
Contractor: Plumbing
LARRY DURHAM CONSTRUCTION
2131 GOODALL CT
LAKE OSWEGO, OR 97034
PHONE: 503 - 699 -8758
FAX: 503 - 697 -6935
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: �' Permittee Signal e. /
CaII 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.
Plumbing Permit Application
Building Fixtures RECEIVES 1 011 ICL . , USI .ONLY l'
' City of Tigard Received .J Permit No.: m
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Il
u 13125 SW Hall Blvd., Tigard, OR 97223 4 P R 7 " i j Date /By: �� " I ZQ `� �� ��
C. Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit No.:
Inspection Line: 503.639.4175 D ate Read /B D S ee Page 2 for
TIG CITY OFTIGARD Ready /By: >
Internet www ti
gard or gov Notified /Method: Supplemental Information
-. BUILDING DIVISI01 SC EDULE ''
PP
': :TYPE O WO RK z. x' ' 3' FEE *, .
. , . , ' < . ,. � E .... R m
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. Ea. Total
Addition /alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
' €` CATEGORY OFSeCONSTRUCTION SFR (1) bath 312.70
[X 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
/ Accessor building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION '' Site utilities:
Job site address: / 6 ) S Ceps- C -� IC Catch basin or area drain 18.76
�_ line, Drywell, leach li or trench drain 18.76
City /State /ZIP: / ( Project name: 5'.7a(- 2
Footing drain (no. linear ft.: _ ) Page _
Suite/bldg. /apt. no.: Project name: Cc., Ci-eQ Manufactured home utilities 50.03
Cross street /directions to job site: Manholes 18.76
I Rain drain connector l t 18.76
af
c„..........._ c„..........._ 7 01„,„.. 4 / m Sanitary sewer (no. linear ft.: _) Page 2
� - ' 1 1 / 1.e.„ Sanitary
sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
' DESCRIPTIONOF' WORK " i <�° Backwater valve 12.51
25.02
K O 1e4._ e {. c.a e Sa. r il r C e_ 1 L "Q Dishwasher 25.02
� \r... -- c I, if Wt t-sba Drinking fountain 25.02
Ejectors /sump 25.02
Ex ansion tank 12.51
PROPERTY O WN_ l' ;❑ TENANT .t ,�; p
( P� Fixture /sewer cap 25.02
Name:
� � \ r w
l6-G l ,� c-,5 � 4 . Floor drain /loor sink /hub 25.02
Address: 343. ) V r
) 5(„
Q 0 � Garbage disposal 25.02
City /State /ZIP: C,, 9 7c 3 S Hose bib 25.02
Phone: ( - 3 S/ '-77 Fax: Ice maker 12.51
' APPLICANT ,- ❑`CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
- - \c.- , S C C,,,,c
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: : ( ) rub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTR r.rt,
�'� �� � � water heater 37.52
Business name: � 1�� ��Ms� Water piping/DWV 56.29
Address: e � ` 1 ���� sc,- . i Q C _; f Other: 25.02
City /State /ZIP: L , v `/ e 0, 563 9 70 3'-1 Subtotal
Phone: ( ) l Fax: ) Minimum permit fee: $72.50
CCB Lic.: ( Plumbing Lic. no.: l Plan review (25% of permit fee)
1 1 °� ` State surcharge (12% of permit fee)
Authorized signature: r ` OP TOTAL PERMIT FEE 1 _Zip`
Print name: \ Date: Q This permit application expires if a permit is not obtained within 180 days
- / after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
I.A Building A Permits VI'I.MU- 1'ermitApp.doc 10/01/09 440- 4616 " 1(10 /02 /COM /WI1B)