Permit CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit #: PLM2010 -00121
TiGARE) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/16/2010
Parcel: 1S135BC00500
Jurisdiction: Tigard
Site address: 10770 SW CASCADE AVE
Subdivision: Lot: 0
Project: Paradise Harley Davidson
Project Description: Replace Water Heater
Owner: FEES
JOHN DURBIN & ASSOC OF OREGON LL Quantity Description Date Amount
10770 SW CASCADE AVE
TIGARD, OR 97223 1 ea Water Heater 04/16/2010 $37.52
PHONE: 1 12% State Surcharge - 04/16/2010 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 04/16/2010 $34.98
Plumbing
Contractor:
MR ROOTER PLUMBING
PO BOX 789
GLADSTONE, OR 97027
PHONE: 503 - 653 -5301
FAX: 503 - 653 -5376
Type of Use: COM
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. Spe .Ity Codes and all otktr
applicable law. All work will be done in accordance with approved plans. This permit will expire if work no started within :0 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to fo ow the rules adoptd by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952-001-0100. You ay • • . . .y of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
icik Issued By: ,v\ &\/ Permittee Signature:
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.
Apr. 16. 2010 7:56AM No. 2117 F. 1
Plumbing Permit Application RECEIVED BuYlding Fixtures •4 ' ` TOR f L r"4 ;a l"` x l E 'S '4,
anal, �� OV`�3�,r11.w,��'�'�,�I+Ld��., �t+ JF . b; NeL ti ?i_+�r,k'tJ�i'ilrs�i'ix�4t ^ + n5 1'1r� % •
F r{ el City of APR 1 6 2010 Received
Permit rr Dale/Hy: �7-M �C�l Q (:� i
, r 13125 SW Hall Blvd., Tigard,OR 97223
Plan Review
V;; .:i - : Phone: S03.639.4171 Fax: 503.598.11 OF TIGARD Date/9y: Other permit l'o..
11t464, 1�'
Internet: Inspection Line: 503.639.4 Internet: wwW.li and or. ov
BUILDING ING DIVISION Date Ready/By. lusts: el See Page 2 for
�
g g Notified/Method: Supplemental information
TYPE OF WORK PEE' SCHEDULE
Q New construction ❑ Demolition For special id use Medlin
Description 1 Qty. 1 E. l Total
' Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 fl. for each utility connection)
CATEGORY OF CONSTRUCTION • SFR (1) bath 249.20 _
❑ 1- and 2- family dwelling gCommercial/induslrial SFR (2) bath 350.00
C] Accessory building ❑ Multi- family
SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other; - Fire sprinkler (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
lob site address: try-'7D 45k. ' 1/ � c>._Ye.1 Catch basin or area drain 16.60
City /State /ZIP: 1 1 CV A, c)-a___. 11 L1;3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ` 1 I Project name: Footing drain (no. linear fl.: ) Page 2
Manufactured home utilities 110.00
Cross strecUdircdions to job site:
�� bppp ,,,___
Manholes 16.60
e Rain drain connector 16.60
Sanitary sewer (no. linear fl.: ) Page 2
__ M � Storm sewer (no. linear 11.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear it.: ___) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16,60
P-9,9 DESCRIPTION OF WORK Backllow prevcnter Page 2
� 4 �C 11 _ I t , w h • ' Backwater valve 16.60
CJ Clothes washer 16,60
Dishwasher 16.60
Drinking fountain 16,60
et-.., PROPERTY OWNER ❑ TENANT Ejectors/sump 16.60
Name: IDOL - , 0 Z V .,\ ■ . � -15 ‘( - N Expansion tank OM 16.60
Address: n n 1 Fixture /sewer cap 16.60
City /S1atc /ZIP: �t t"' �' _ Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
`APPLICANT ❑ CONTACT PERSON Hose bib 16.60
1 l ice maker 16.60
Business name: 1v\ 2 _ i� 1 um bt
Interceptor/grease trap 16.60
Contact name: Medical gas (value: $_) Page2
Address: (j L b 1.- Primer 16.60
City /State /ZIP: (n I 1 M • er760; `1 Roof drain (commercial) 16.60
Phone: 'JP)) 1953 5'5 3 ax:: ( ) ( 3 53-)(,, Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -marl' . _ Urinal 16.60
CONTRACTOR Water closet II 16.60
-
Business name: + � Water heater 16.60
Address:
.91.., r Other:
City /State/ZIP: • � ' Subtotal
Fax: minimum pemtit fce: $36.25
Minimum permit fee: S72.50
Phone: ( )
0-1111)\ ( ) 1 1\ Residential backllow
CCB Lic.: 1 3c6C^1 ... Plumbing Lie. no -: .1,„gp�j�2►.1 Plan review (25% of permit fee)
Authorized signature: State surcharge (12% of pemrir fee)
wY `"" - TOTAL PERMIT FEE
Print name: e,KyA C-� i r-cc r Dale: ` 6 ` lO This permit application ripireS 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.
N0uild ;n5TermitOLNff- PermirApp.doc 12/17/06 4 - I0A4 616T(I0,'02 1COMPVEB)