Permit ' "' CITY OF TIGARD PLUMBING PERMIT
, ,5= m COMMUNITY DEVELOPMENT Permit #: PLM2010 -00176
,,
Date Issued: 06/02/2010
T F dA 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 136AD04400
Jurisdiction: Tigard
Site address: 6721 SW PINE ST
Subdivision: Lot: 0
Project: Cornish
Project Description: Repair /replace 20' of sanitary sewer line.
Owner: FEES
CORNISH, MARY D Quantity Description Date Amount
6721 SW PINE ST
PORTLAND, OR 97223 20 If Sewer Service 06/02/2010 $62.54
1 12% State Surcharge - 06/02/2010 $8.70
PHONE: Plumbing
10 ea Minimum Fee Adjustment - 06/02/2010 $9.96
Contractor: Plumbing
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503 - 239 -8801
FAX: 503 - 669 -9568
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 ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility q ication Center. Those . - are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. Yo ay obtain a copy of the rules
or dj ect questions to OUNC • callin g 60 46.6699 or 1.800.332.2344.
Issued By: / `r / Per ittee Signature: �.
—r4r/A.14-4/ l e , l( 6 - 12 .----- 1
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.
Jun. 2. 2010 9:26AM No. 2169 P. 1
Plumbing Permit Application
Site Utilities ��` ��
City of Tigard A E ,mot V D al e /By : L o o � / D Perm 1f `o — oci ? {e
a 13125 SW Hal] Blvd„ Tigard, OR 9722 t
Pan R.er� eW
111 • : Phone: 503.639.4171 Fax: 503,598.1960 +t OA O % 2. Other Permit No.:
J
T1 Ready/By: —� DatetBy:
Inspection Line 503.639.4175 Da Read riots: _ ® g See Page 2 for
Internet '�
www,tigard- or,gov � t' _ Aft ti8edlMelhod: ] Supplemental
d/
t
!, ....' TYPE OF WORK a . r1V - 1 .r _ - FEE* .SCi•IE DAL
1 11
In New construction ❑ De ' [ion For special information use checklist.
Description Addition/alleration/replacement 1=1 Other: New 1- 2 -famil dwellings (includes 100 A. for each utility connection) • CATEGORY OF CONSTRUCTION . SFR (1) bath 312.70
!I 1- and 2-family dwelling 12 Commercial/industrial
SFR (2) bath 437.78
❑ Accessory building r ❑ Multi - family SFR (3) bath 500.32
Laeh additional bath/kitchen 25.02
❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Pagc 2
x013 SITE 'I NFORMATION AND LOCATION Site utilities:
Job site address: / • ` A P Catch basin or area drain 18.76
Drywell, teach line, or trench drain 18.76
City /State /ZIP: : �6� J_ iI i Footing drain (no. linear 11.: ) C Pagc 2
Suite/bldg./apt. no.: Project name: ,M Manufactured home utilities 50.03
Cross slreeddirections to job she: Manholes ■ 18.76
Rain drain conncctor 18.76
At ' Sry e (no. lar 11.: ell) IE Page 2
se ft.: ) Page 2
Water service (no, linear ft.: ) Pagc 2
Subdivision: '4 Lot no.: Fixture or item:
Tax map /parcel no,: Backilow preventer 31.27
. DESCRIPTION. OF WORK nc
water valve 12.51
Clothes wash
25.02
_ fit. ! .# •� Dishwasher 25.02
Al e .„ Drinking fountain 25.02
Ejectors /sump 25,02
❑ PROPERTY OWNER ❑ TENANT .,
Expansion tank 12,51
Name: / Q , . Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25,02
Address; Garbage disposal 25.02
City /State /Z1P: _ Hose bib 25.02
Phone: ( ) Fax; ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ _ ) Page 2
Primer 12,51
Contact name: _ Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
—
City /State /ZIP: Solar units (potable water) 62.54
•
Phone: ( ) Fax: : ( ) Mb /shower /shower pan 12.51
Urinal 25,02
E-mail: Water closet 25,02
CONTRACTOR ...... .
Water heater 37,52
Business name: `. sob . y 11 Water piping/DWV 56,29
Address: LAS i 1 t • 42 Other: 25.02
C) a SttbtolAI
City /State /ZIP: 9 ' ( , . . _
Phone: ) ' Fax: • 696, V ./ Minimum permit fee: $72,50 '7 - '.
Plan review (25% of permit Cec)
CCB Lie.: rk I Plu _ . ,. -`�• mbin: L'e. no
1 Siete surcharge (12% of permit fee) f5",70
1 Authorized signature: M TOTAL PERMIT FEE • ,
This permit application expires it a permit is not obtained within 180 cloys
Print name:. 0 _ • Date: ,, , - ��, after It has been accepted as complete.
'Pee methodology seI by Tri- Counly Building Industry Service Board.
I: U) uildi° g rPermirstPl.A1- PerrcliApp.dot 10lnil00 440 -1616T(10r07 /COWM'Ea)