Permit CITY OF TIGARD PLUMBING PERMIT
of e
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00208
v . Date Issued: 06/25/2010
Ti{,ARU. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S110AD08600
Jurisdiction: Tigard
Site address: 10505 SW CANTERBURY LN
Subdivision: Lot: 0
Project: Stapleton
Project Description: Replace 68' of sewer line.
Owner: FEES
STAPLETON, ELEANOR A TRUST Quantity Description Date Amount
10505 SW CANTERBURY LN
TIGARD, OR 97224 68 If Sewer Service 06/25/2010 $62.54
PHONE: 503-639-3589 1 12% State Surcharge - 06/25/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 06/25/2010 $9.96
Contractor: Plumbing
JACK HOWK PLUMBING /RESCUE ROOTER
P.O. BOX 2830
CLACKAMAS, OR 97015
PHONE: 503 - 850 -3100
FAX: 503- 491 -2932
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 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 dire questio to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu d By: g 4 Permittee Signature: �\ r
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 ONLY
City of Tigard Reee,yed
IMP
v 13125 SW Ball Blvd.. I'iF�ard. OR 97223 Rec e i fay < awls Pc N o.. 1 a - «) � O �
Phone: 5U 3.63t1.� 171 Fax: 503.59 3.19611 Plan Review
Inspection Line: 503.639.4115 Dan'Fiy: Other l'cnnn No .
TIGARD Date Read.13y ® See Page ?for
Internet: uwu.tigard or.goy
Nonficdr,Meihud. Supplemental Information ,
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
1 Addition /alteration /replacement El Other: Description ()Is. La loud
New I- 2-family dwellings l includes 100 II. kw each utility ctnincctum f
CATEGORY OF CONSTRUCTION SIR (1) halo 312 70
I -and 2-family dv\ellin ❑ Commercial /industrial SFR (2) bath 437
❑ Accessory building ❑ Multi - family
SFR (3) bath 500.32
Each additional bath /kitchen 2; 02
❑ iklaster builder ❑ Other:
Fire sprinkler ( sq. ft.) page 2
JO11 SITE INFORMATION AND LOCATION Site utilities:
Job site address:
• I
�j Lae .- Catch basin or area drain 1 8.76
City/State/ZIP: : / �� I Drywell. leach line, or trench drain 18.76 MI
�► tir Footing drain (no. linear It.: ) _
Suite /bldg. /apt. no.: Project name: ®
� II Manufactured home utilities 10 03
Cross street/directions to, job site:
■
Manholes 18.76
# LT�N _ f 'C L, 0 Rain drain connector 18.76
Sanitary sewer (no. linear ft.: mg+ Page 2
/�
Storm sewer (no. linear fl.: _) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Back flow preventer 31 27
DESCRIPTION OF WORK Backwater valve ■ 12S 1
-♦ Clothes washer
_ ; 5 $ 1 , ` ! �.... .` IIIIMMEI
�) _ Dishwasher
25.02 ill
Drinking fountain 25 07
Ejectors /sump 2 5 02
PROPERTY OWNER 12 51
0 TENANT Expans tank
Name: — 1 0 / Fixture /sewer cap 25 02
Address: -� !`'� � it ` I/ Floor drain /floor sink /hub 25 0
Garbage disposal
City/State /ZIP: ! 25 -02
�. Hose bib 25.02
Phone: — sccci Fax: ( ) Ice maker
� 12.51
' ir APPLICANT . ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ARS dba JACK HOWK/RESCUE ROOTER Medical gas (value: $ ) Page 2
Contact name: JOYCE DENNIS Primer 12.51
- Roof drain (commercial) 12 51
Address: PO BOX 2830
—
Sink/basin/lavatory 25.02
City /State /ZIP: CLACKANIAS, OR 97015 Solar units (potable water)
62.
Phone: (503) 850 -3100 Fax: : (503) 491 -2932 Tub /shower /shower pan 12 51
E -mail: joyce(a)jackhowk.com Urinal 25 02
CONTRACTOR Water closet 25.02
•
Water heater 37.52
Business name: ARS dba JACK HOWKIRESCUE ROOTER
Water piping/DWV 56.29
Address: PO BOX 2830 Other:
25.02
City /State /ZIP: CLACKAMAS, OR 97015 Subtotal
MN
Phone: (503) 850 -3100 Fax: (503) 491 -2932 Minimum permit fee: $72.50 NMI
CCB Lie.: 127325 Plumbing Lie. no 3 168P6 Plan review (25% of permit fee)
Authorized signatur. . 1
State surcharge (12% of permit fee) MI
GAL. ,�\ TOTAL PERMIT FEE N
Print na �� , i I� . Date: ate D( e This permit application expires if a permit is not obtained within 80 days
1 ■ ■ ■��efff��� i Die / This
methodology set by T Co il nty Building Industry Service Board.
f \ Building \Permits \PLMU- PermitApp.doc 10 /01 /0 Please FAX PERMIT COPY to: 503- 491 -2932