Permit t, 1 , _ CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit #: PLM2010 00086
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/23/2010
,,,a, ,.,, ,-I, .. .,,, Parcel: 2S112CD07300
Jurisdiction: Tigard
Site address: 15838 SW 76TH AVE
Subdivision: PP1994 -100 Lot: 1
Project: Smith
Project Description: Replace 40' of water service from meter to crawl space.
Owner: FEES
SMITH, ROBERT Quantity Description Date Amount
15838 SW 76TH AVE
TIGARD, OR 97224 40 If Water Service 03/23/2010 $62.54
PHONE: 503-598-1975 1 12% State Surcharge - 03/23/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 03/23/2010 $9.96
Plumbing
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005
PHONE: 503 - 643 -7619
FAX: 503 - 643 -7620
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: % / P ermittee Signature: .A7 ,,-612 t , 770
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.
I'(ar 19 2010 3:20PM BEAVERTON PLUMBING INC. 5036437620 page 2
Plumbing Pelrmit Application RECEIVED
Building Fixtures 7 x ." '° l I (o It ti'I`IAI( -1 (tttil t> ?I , l r ,c x
MAR 1 8 C ,f Receiv t ,.A . a ' . , ,.
r City of T igard Day 3/O5 / /a ,<' Permit No 0/0 - DOD F'
Hall Blvd., Tigard, OR 97223
13125 S W Phone: 503.639,4171 Fax: 503.598.1 i OF TIGARD Plea Review a Pmt No :
S ii e i, l, t i .., Insp ection Line: 503.639.4175 BUILDING DIVISIOI DamRead 1 ® SeePage2tor
hx Internet: www.tigard- or.gov Notified/Method: 1 Sa. . eels! Information
.t t 1, i � �, I Y s A[ `:G tt r. I r ; r r, ^, : J b ..'f -k x ... '.tN ,; : i x r , wt ,C ::�53 tt t t .• -".(F f eh..lt t { 1 WRrtx�, t
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. ,y," �� : free. s uJ�: u: d. cs,...:: r u��a ..�:. �.:�... rt ..- :.�:..�! _: s:: az. .. 7�^t. ±_;i:u4�xix.�.ar..ar�x+ rn _'. :iv�...�`..ril,r_w.c`?:�..i �u��?i.. � � ..
❑ New constriction ❑ Demolition For special 1rtlorwtatlon use cJreckpst
Description 1 Qty. 1 Ea. 1 Total
® Addition/alteration/replacement ❑ Other: New 1- 2 -family dwellings (includes 100 ft for each utility connection)
.; e i "Ot @,f,, x .. "�'� 1il x , s � 6y -,.� -�P: SFR (1) bath 1 312.70 )
Ftdoi)2.11#. 4
: /i' .....ttlemie14 ,1..,,wic...,< 1:: -... _ >14.:It. j a`_:?4:1 5_i"ihle
® 1- and 2- family dwelling ❑ Cornrnercial/industrial SFR (2) bath 437.78
❑ Accessory building
SFR (3) bath 500.32
❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other Fire sprinkler ( sq. ft) Page 2 I
+ 1:1) :r }. . [. r iL%" : -u :s s. : ..r... _,. .' ..; Ye: :c. .saSu ?iis:,,:� 41 .a: :a.. , t + 1/4 . ?1 1 tttif i S ite utilldes:
Job site address: 15838 SW 76 AVE Catch basin or arcs drain 18.76
Drywell, leach line, or trench drain 18.76
City /State/ZIP: TIGARD, OREGON 97224 Footing dram (ra. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: ROBERT SMITH Manufactured home utilities 50.03
Cross street/directions 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 (no. linear It: 44) 1 Page 2 62.54
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31,27
{ .� fi of [ ✓$ S' ' fF'� ['� ta w F s l c t : r ∎ li ly a Backwater valve 12.51
. . rt,t.: 16:i � X.:. :.� , , . .. :: ,,.. z:: 1.:._...t f.: ++ '..20. : :. ) _.._.,1.....i [∎ x,,_ , Clothes washer 25.02
REPLACE THE WATER SERVICE FROM THE METER TO THE CRAWL Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
a , + q. a "ai r ',4,,4a < ',is. sy ..s, iyM
is : 3 " i S , i X , t Q .i"" .1'' , r x Expansion tank 12.51
9 . c�. a. i;. �.. nx�,._, i.. �:. u. � .....:�w.... ?s... :s._p;..,r¢.n a x.a�i,��_. r..L.,.rit:._4r•r. � : .�.._r �Sa.^
Name: ROBERT SMITH Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 15838 SW 76 AVE
Garbage disposal 25.02
City/ State/ZIP: TIGARD, OREGON 97224 Hose bib 25.02
Phone: (503)598.1975 I Fax ( ) Ice maker 12.51
c',t Nr'r". T ' (i 1 :�y I i �6 7 I ` t� r i) ti!'X,i £ t + +.i, r .'. j F ix [..� lnterc tor/ e tr 25.02
��4 .� �a . 5: r. i �. r ...i �._1.�._+',.t_. . ,c: +,. F:'.,���:..SJ���:.ct,.L, tfcr::,. ....ii.�ne_r: ;rx..,
Business name: BEAVERTON PLUMBING, INC Medical gas (value: $ ) Page 2
Contact name: SUE DEAN Primer 12.51
Roof drain (commercial) 12.51
Address: 13980 SW TUALATIN VALLEY HWY _ Sinklbasin/lavatory 25.02
City/ State/ZIP: BEAVERTON, OREGON 97005 Solar units (potable water) 62.54
Phone: (503)643.7619 Fax : (503) 643.7620 Tub/sbower /shower pan 12.51
E -mail: Sue(beavertooplumbing.cam Urinal 25.02
ter' 3V « l g I� a • r „ r :b 1 a`?, [ 1 Water clO3e1 25.02
i x i . � 5 t . ,ri A , _ r At a s [ , .,, : txl; 1 . ,7r " 1 � _
- � 1. ..,a _,.:. -,, .2r., :: L_ z ,.....t ._... ,s,;� : .fix .al s: r n>)t � ' Water heater 37.52
Business name: BEAVERTON PLUMBING, INC Water piping/DWV 56.29
Address: 13980 SW TUALATIN VALLEY HWY Other. 25.02
City / State/ZIP: BEAVERTON, OREGON 97005 Subtotal 62.54
Phone: (503)643.7619 Fax: (503) 643.7620 Minimum permit fee: $72.50 72.50
Plan review (25% of permit fee)
OB Lic.: 12889 Plumbing Lic. no.: 34-4PB State surcharge (12% ofpermit fee) 8.70
Authorized signature: -\ TOTAL PERMIT FEE 81.20 t/
Print name: SUSAN DEAN Date: 3/19/2010 This permit application expires it a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by Tri-County Building Inangry Service Board_
1: 113,itdiosu'i.mivaLMU- PamitApp.doc t0N1)09 440.4616T(10/02 (COMAV S)