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Permit Rr�,� CITY OF TIGARD PLUMBING PERMIT ,�4 COMMUNITY DEVELOPMENT Permit #: PLM2009 -00317 Yx; ri Date Issued: 11/03/2009 wrT [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S109AB04600 Jurisdiction: Tigard Site address: 14268 SW 134TH DR Subdivision: THREE MOUNTAINS ESTATES Lot: 39 Project: Spezza Project Description: Install lay in bar area of game room. Owner: FEES SPEZZA, BUD Quantity Description Date Amount 14268 SW 134TH DR TIGARD, OR 97224 1 ea Lavatories 11/03/2009 $25.02 1 12% State Surcharge - 11/03/2009 $8.70 PHONE: 503 - 590 - 4778 Plumbing 47 ea Minimum Fee Adjustment - 11/03/2009 $47.48 Plumbing Contractor: OWNER PHONE: FAX: 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 • • . •• - -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or • • ect questions to Ob C b .fling 503.246.6699 or 1.800.332.2344. I .sued By: , // I 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. Plumbing Permit Application Building Fixtures FOR OFFICE USE ()NIA City of Tigard DateBy: �� ©d • arm Permit No.: / Azy Gb. l a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ■ Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: . 1 . 1 C'\ R D Inspection Line: 503.639 Date Ready/By: ' : ® See Page 2 for Internet: www.tigard or.gov Notified/Method: I(, Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement Other: f7 p99 (1( t>Fj New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ 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: L 41 2....b ' . I r `J 1.-1:-.1-4 s' Catch basin area drain 18.76 City /State /ZIP: v rLV �D C- Drywell, leacch h line, or trench drain 18.76 '�� I Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: ,j 4Zp` 5 - 16.471;7, 14 Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 P )t l _- , v - UJ' � f/ p , ` � / Rain drain connector 18.76 Y r ` Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 {� Clothes washer 25.02 �t7 - ��t`-� l - 4 C Jej Dishwasher 25.02 1 .Q(/14 �-- /t Drinking fountain 25.02 Ejectors /sump 25.02 D PROPERTY OWNER TENANT Expansion tank 12.51 Name: F2Uh Pg� t� Fixture /sewer cap 25.02 Floor drain /floor sink/hub 25.02 Address: '5,W1 E Ou Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: (5O3) j 10 - 4. -- 7 Fax: ( ) (J6N� Ice maker 12.51 Ltd' APPLICANT lJ� CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Contact name: G G ' J� Primer 12.51 � Roof drain (commercial) 12.51 Address: Sink/basin/lavatory I 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 CONT CTOR Water closet 25.02 Water heater 37.52 Business name: O Yom/ v { e7U1L-1:1512_ r 7 Water piping/DWV 56.29 Address: t Other: 25.02 City /State /ZIP: Subtotal ( Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7 a. Plan review (25% of permit fee) CCB Lic.: P bing Lic. no.: State surcharge (12% of permit fee) e , la Authorized signature: )( TOTAL PERMIT FEE g ( . 9,0 (' This permit application expires if a permit is not obtained within days Print name: I n 1 Date: after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02JCOM/WEB)