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Permit CITY TIGARD PLUMBING PERMIT ' � 11 4, DEVELOPMENT SERVICES PERMIT #: PLM2005 -00221 : DATE ISSUED: 5/31/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 102BB -02100 SITE ADDRESS: 10000 SW MOLLY CT ZONING: R -4.5 SUBDIVISION: MOORE'S MEADOWS LOT: 002 JURISDICTION: TIG Project Description: Install residential backflow prevention device. CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES LUPE SANCHEZ Description Date Amount 10000 SW MOLLY CT TIGARD, OR 97223 [PLUMB] Permit Fee 5/31/2005 $36.25 [TAX] 8% State Surcharl 5/31/2005 $2.90 Phone : 503 968 - 0109 Total $39.15 Contractor: BRUNER PLUMBING PO BOX 23985 REQUIRED ITEMS AND REPORTS TIGARD, OR 97281 Phone : 503 624 - 4880 Reg #: LIC 81837 PLM 26 - 445PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 9524: • -1 1 s • ough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by c- ing 503 - 246 -669' • 1i80; 332 -2344. Is ued By: /' �/ �L �! % Permittee Sign • /�/%J� �� 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. FROM : BRUNER1PLUMB I NG FAX NO. : 6242173 May. 27 2885 12:12PM P2 Plumbin Permit Application .. F OR.o F FICL USE • ONLY ` , - g " Received i � City Of Tigard Date/13y: 5p OJ Permi Np.: ��Q �/ 131 25 SW Hall Blvd.. Tigard, OR 97223 _ ...... • - -- - b` Plan Revtew Phone: 503.639.4171 Fax: 503.598.1960 7 ia !'rt� Datc/Fly: Other Permit No. 24 Hour Inspection tine: 503.639,4175 t j pate Ready/By Jur 0 See Page : for Internet: www.ci.tigard.or.uS Noufiod/MCthat: / /as Supplemental Information - - vim ,:,..: .,:, . �. :. _ ,•�,. . < . .. .. .. . , .. _ . FEE* SCHEDULE • • ❑ New construction I' ❑ Demolition r , _ Fors , 1al information �ese check(t3 -- -. ....... Description 1 ._ Qty 1 F.a. I Tom: Y4 Addition/alteration/replacement ❑ Other. New 1. 2-family dwellings (includes 100 tt. for each utility c irn_c :.or:'i i' : ',5: • :_ �fvv#'_� t. : �,;'��' ' ,,., „, .. : : ... SFR (1) bath - !89.20 X rL '.. � . ,. � ? :�_, . "- i,.....!7�1�k.1.aJ!.rf•: �(. «. -: :eau "��a!;�.9.. ..�, , ;��y x��. :. ',.",� - , I •and 2-fa -family dwelling V ❑ Commercial/industrial SF'}t (2) bath I 350.00 , SFR (3) bath 399.00 0 Accessory building ❑ Multi•family - -- ^ Each additional bath/kitchen 45.00 Other: ❑ Master builder CI Other: sprinkler sq. ) b F spri 1 1 r( 5 f�- Page 2 tic. ., y N •'r j `i� :y :w: �'� . Y,' :w%,,: , '� =1� • { : «'` ,>r:�r. � . , ...e : ,, , r ,�1�&�' ;J�1© W . . , ,., ,- ;/: :.l. -�" 4 ,, : S utilities Job site address: • , Lj d00 1 41, o J Catch basin or area drain l6_60 1 • • City/State/ZIP: Drywell. leach line, or trench drain 16.60 ,- Suite/bldg. /apt. no.: Project name: • ' / 1 Footing drain (no. linear ft.: ) Page 2 J Manufactured home utilities 110.00 Cross srreet/directions co job sites Manholes 16.60 I c J2d "i �,, - j,�;i,Q1_ Wg - iLd T Rain drain connector 16.60 ; „ J n �` Sanitary newer (no. linear ft.: Pagc 21 i 1�'N Storm sewer (no. linear ft.: ) Pa 2' . Subdivision: 1.ot no.: Water service (no. linear ft.: ) Page 7 • L-.. ---- Fixture or item Tax map /parcel no.: .. - , i :. ,L,•e;: -,;_ ,,i,. h - - . ... b i valvc Asorpton vavc .._. 16.60 • �* :.�, : ; :: Page z - 5Z9.,„2.5 • :� :' :... 4:`r.. ? :;F.. .a•c :G?.,w � "�r...5�'.•:�nL._. -- .A•..�,.A .. 9�... �1�L ?. ` •1„ � �,��' :; '"` � " .. , ... .. BaCkI]OwprCvelttCr ..... �-. ;. /�f� Backwater valve . 16.00 �5-a Clothes washer 16.60 _ 16.60 u:�- ,`+j-' -'wn'S `(;i,:.. •rrc' n: io „L`f; c;�..- ,�,". -- wv r : :,�...•�_ Drinking fountain v rM 16 60 ±;�. :vr � „ �. {J•'�• : �_ "._. ". ____. �; .p Pf'sltff `Q;4 x : �(Al�Pl "lit, .:x wra. : k :.�.... e = . turn su 16.60 • Name: t' t x , �„ ^ 1 C t-f' 2 M _ Expansion tank _ ^ ^^ 16.60 I Address: l I Ixture/ ewer Cap 16.60 Ciry/State/ZLP: Floor drain /floor sink/hub i 6.60 Phone: (Sp$) 9LOS' q ,T IO / Fax: ( ) Garbage disposal - . 0 <.:•� Ala! ✓v,rvy \v?8 : ^' vattir:, t ,� r ;G .- T i2 Hose bib 16.60 1b 6 y «.$ ,:`; J'�Ks '..,.,:t . r 1 :tie r 4�.,1, �) T • ;d A ?ua . : , ...Y="i4t .4 1.;'. - .' . • `•.17 ,. ice m9 ker 16.6 I Business name: ' Interceptor /grease trap 16 (i0 . • Contact name: Medical gas (value: $ ) Page 2 I 1 Address: Printer - 16.00 - City /State/ZIP: Roof drain (commercial) _ 16 60 I _, - -- Sink/basin /lavatory 16.60 j Phone: ( ) Fax:: ( ) • - -- Tub /shower /shower pan 16.60 - E -mail: Urinal 16.60 'i' 't j' r rxt + ,J N ;' 'w � V� Se• r �`• • :.i i Watei clnsct I (). bt) . , �Y. .... : psi f ^s: • a. '.�-: i n u . .. _._. Business name: Ti(` L ( / t/le.1 --" -� �,i A/fl j , Water heater 1 6.60 Address: C) 80 a 9 Other: - -- • • 0 1 Su btoral l City/Statc/ZLP: cnp� 7 I P �;, � � � ,�_. Minimumpermit $72.10 Phone: (J13) (� _4 cL7() Fax: (5 (pa ( '1 --t) Residential backtlow minimum permit foe: $36.25 I .5 (p. S C:CB Lic,; Plumbing Lic. no.: Plan review (25% of permit lee) I ; mi l. -3 � a� " State surcharge (8% of permit fee) 1 .t.(3 Authorized signature: u TOTAL PERMIT FEE j Print name: VV a h• - r'G4 /oe--N Date :5( a.�eD This permit application expires if a permit is not obtained within 180 days a fter it has been accepted as complete. *Fee methodology set by Tri- County Building Indusny Service Board i:\ Building \Pcrmit &U'LM- Atrmicnpp.doc 12/03 440- 4616T(J 0 /02 /COM.tW a)