Permit N 1 Ti PLUMBING PERMIT
li il
0, q CITY OF TIGARD
P =a COMMUNITY DEVELOPMENT Permit #: PLM2010 00172
i a Date Issued: 06/01/2010
IT{GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
,,., , ,v „ Parcel: 1S 134AD07300
Jurisdiction: Tigard
Site address: 10557 SW WINDSOR PL
Subdivision: WINDSOR PLACE Lot: 10
Project: Lipscomb
Project Description: Replace 50' of water service. Electrical permit may be required if replacement piping effects
house grounding.
Owner: FEES
LIPSCOMB, THOMAS R III & JANIELL Quantity Description Date Amount
10557 SW WINDSOR DR
TIGARD, OR 97223 50 If Water Service 06/01/2010 $62.54
PHONE: 503-620-9161 1 12% State Surcharge - 06/01/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 06/01/2010 $9.96
Contractor: Plumbing
CASEY'S PLUMBING
PO BOX 30075
PORTLAND, OR 97294
PHONE: 503 - 253 -0030
FAX: 503 - 262 -8251
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 N • cation Ce - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di ct questions to OUN .y calf•. 503.246.6699 or 1.800.332.2344.
Iss ed By: e /`/ / . Permittee S'. - �� i • � '
Call 503.639.4175 by 7:00 a.m. for an inspection that bu- ness 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.
May 28 10 04:30p Casey's Plumbing 5032628251 p.l
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I " City of Tigard MAY 2 8 Received
Date/B
2 O O ' I U Perm
n 13125 S W Hall Blvd., Tigard, OR 97223 y: ' ,t No.: �N0 1d -00 79., fir: t C ° Plan Review Other Permit No.:
t v Phone: 503.639.4171 Fax: 503.5C119rOF TIG • Date/By:
� G RD Inspection Line: 503.639.4175 ^ Date Ready/By: Juris• H See Paget for
.r: Internet: www.tigard or.gov BUILDING Div;' °,;.. Natified/Method: -7/" Supplemental Inforination
TYPE OF WORK FEE* SCHEDULE
0 New construction ❑ Demolition
For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New l- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Cl Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: 1(a .. �� n , Catch basin or area drain 18.76
City / State/ZIP: '� �� � (� �-�j O\ Drywell, leach line, or trench drain 18,76
" �� O�� Footing drain (no. linear ft: ) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
���CA Rain drain connector
18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear (1.3 0) ' Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax ma parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
a -✓ 0 )4--t - Ce Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
r ROPERTY OWNER 0 TENANT Expansion tank ' 12.51
Name: --.....0....x--.--.....0....x--.....0....x--..e Q_ \ " i " � U - _ Qom,\ - Fixture/sewer cap 25.02
Floor drain/floor sink/hub
Address: ` CO t Is Y‘r �r G
x !A f F 25.02
Garbage disposal 25.02
City /State/ZIP: `- "a(al\C -, M 1
�� Hose bib
Phone: ( i�) ( - K. Q 12.51
. Fax: ( ) Ice maker 2
V APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: �` �x ' c7 'PLrn Medical gas (value: $ g
� 1 �� ) Page 2
Contact name: ;Z /� �S� Roof drain (commercial) 12.51
Primer 12.51
Address:
LJ \ C.0
....Se
p '"K 3 Sink/basin/lavatory 25.02
City /State/ZIP: PNe-AA Ul'l c.� I () c 1 `1 9 LA Solar units (potable water) 62.54
Phone: ( ) < a ) C , c - ) - F :: ( ) a kDa -8a t Tub /shower /shower pan 12.51
E -mail: ail: eiC1NCt.C. A-- ,) C 0Y- Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater
Business name: 37.52
C (.1( l )p ?Lt.t An \EitYl Water piping/Dwv 56.29
Address: (") . �!`�
X- 1�J.?� S Other: 25.02
City/ State/ZIP: ,--t 1 � n � I �'` C] 2_94 Subtotal 72 5C.- hone: (5 ) a c F ax: ) � ( - \,6' Minimum permit fee: $72.50 72..9c. C Lic: t t,,- -1 ' X � �J / !V Plumbing Lic. no.: a -} L. 1� P review (25% of permit fee) �^
Lic.: State surcharge (12% of permit fee) s- 7
Authorized signature: lc I t , I '7 1/i/ '
p � - TOTAL PERMIT FEE g (, Da., name: C 4... la (L ' k e Date• S c o - 1 h This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete. M
*Fcc methodology set by Tri- County Building Industry Service Board.�
I:i Building \Pcrmiu\PLMU•PermitApp.doc 10/01/09 410 1616r(t010 OMItVEB)