Permit CITY OF TIGARD PLUMBING PERMIT
la � - COMMUNITY DEVELOPMENT Permit #: PLM2010 -00083
Date Issued: 03/19/2010
TIGARD` 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111AD16000
Jurisdiction: Tigard
Site address: 14972 SW 91ST AVE
Subdivision: MALLARD LAKES Lot: 26
Project: Danielson
Project Description: Replace existing fixtures.
Owner: FEES
DANIELSON, SHARON Quantity Description Date Amount
14972 SW 91ST AVE
TIGARD, OR 97224 1 ea Clothes Washer 03/19/2010 $25.02
1 ea Dishwasher 03/19/2010 $25.02
PHONE: 503 - 624 -8157 2 ea Hose Bib 03/19/2010 $50.04
1 ea Ice Maker 03/19/2010 $12.51
Contractor: 3 ea Sink 03/19/2010 $75.06
PIPELINE PLUMBING 2 ea Tub /Shower /Shower Pan 03/19/2010 $25.02
333 S STATE ST, STE. V -108 1 12% State Surcharge - 03/19/2010 $25.52
LAKE OSWEGO, OR 97034 Plumbing
PHONE: 503 -624 -1906
FAX: 503 - 624 -1926
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $238.19
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
issued By: /6 0 1 j ;, / � Permittee Signature: oxf 91J/pz few .7777c771V/ /
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.
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: 13125 SW Hall Btvd., Tigard, OR 97223 ,, r , .. r p lan ilzview Other Permit No.:
i' ';'. - :.,' ' Phone: 503.639.4171 Fax: 503.598.19604 1 Y Or / F ) DatelEty:
Inspection Line: 503.639.4175 BUILDNG DIvISICip, DateReaaYIBle ill See Page 2 for
Internet www.tillard-nr.anv Notified/Method: Erdi Sup' -,, -, , informadm
FEE* SCHEDULE
TYPE OF WORK
0 New construction 0 Demolition Descri .tion Kos Ea. Total
L'. Addon/alteration/replacement 0 Other. • New 1- 24amll dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
SFR (2) bath 1111111 437.78
it 1- and 2-farmly dwelling 0 Commercial/industrial
SFR (3) bath 50032
0 Accessory building 0 Multi-family Earth additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler •____ sq. ft.) Pa 2 MIN
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain NIB 18.76
°61 job site address: 1 # 1 1 5 -- \i
ar Drywall, leach line, or trench drain am 18.76
City/Staten?: I T r d. , ca_ °27'-\ Footing drain (rm. linear ft.: ____) Page 2
Suite/bldg/apt no.: _ Project name: ' Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ____,) Page 2
Storm sewer (no. linear ft.: ____) Page 2
Water service (no. linear ft: ____) Page 2
Subdivision: _1 Lot no.: Fixture or item
Backflow preventer 31.27
Tax map/parcel no.:
DESCRWITON OF Backwater vatve 1231
WORK
- . Clothes washer 25.02
/ -
ml- 1 . os.,ii ...1 ai . A a' , 61 A i Dishwasher 1111 25.02
Lk) A • - Drinlcing fountain 25.02
Ejectors/sump 25.02
dPROPERTY OWNER 0 TENANT Expansion tank 1151
Fixture/sewer cap 25.02
Name: //ati 23/9/i Ai Floor drain/floor sink/hub 25.0
Address: --C4 -6
Garbage disposal 25.02
City/State/ZIP: Hose bib 2- 25.02
Phone: (.5 ) y _9/ 5 Fax: ( ) Ice maker i 12.51
0 APPILIC.ANT 0 CONTACT PERSON hitaceptor/greasc trap 25.02
Business name: C i ) l ' R_111(1.0.... Pt Lk tVl \10"-Al\-9 Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 1251
Addrms: Sink/basin/lavatory 25.02
City/Stile/ZIP: Solar units (potable water) 62.54
Phone: ( ) 1 Fax : ( ) Tub/shower/shower pan 2. 12.51
Urinal 25.02
E-mail: Water closet 25.02
CONTRACTOR Water heater 37.52
B na1") I.
asiness rae ?) obelvvL. Plu.A.\\41 Water piping/DWV 5629
Add ress: --) '-) 51 - t. Y) \J 40(9) Other. 25.02
Ci 11),
ty/State/ZIP: ) 0 * L ) mi._ q-74-74,1
Subtotal MN'
Pax: Ctlit5) L ZL2 Minimum permit fee. 5'72.50
6fr cca Lic.: ‘ 5 2AOD 1)/0.7- plumbing Lic. -5bvo Plan review (25% of permit the)
ate surchge of permit fee) 1 MIN,
Authorized sigriaturb k., k-,A,./ i I - 9/ TOTAL PERMTT FEE
Print name: ..,.... ) L. t... 0_, Clow y .c ..
k .A Date: This period' application St ar(Irh lapin:, it a peralit is DOi obtained within 180 days
atter it has been accepted as complete-
.r..........o..4.4..... ..... s,...T.irswates.TholAi.s.