Permit . tq CITY OF TIGARD PLUMBING PERMIT
1 p ii
COMMUNITY DEVELOPMENT Permit #: PLM2009-00340
• . [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/25/2009
Parcel: 2S 111 AB07000
Jurisdiction: Tigard
Site address: 9250 SW INEZ ST
Subdivision: Lot: 0
Project: Geske
Project Description: Replace up to 100 feet water service between meter and house.
Owner: FEES
GESKE, FRANK Quantity Description Date Amount
9250 SW INEZ
TIGARD, OR 97223 100 If Water Service 11/25/2009 $62.54
1 12% State Surcharge - 11/25/2009 $8.70
PHONE: Plumbing
10 ea Minimum Fee Adjustment - 11/25/2009 $9.96
Contractor: Plumbing
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062
PHONE: 503 - 691 -6166
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 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: I ' Perm ittee 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.
pi ,tNov, 25. 2009 2:13PM Modern Plumbing No. 7060 P. 2
Plumbing Permit A t tlication RECEIVE 1
Building Fixtures POR 01:1.1 '1: l SF; ONI,,'
City of Tigard NOV 2 5 2009 Received
III 4 13125 SW Ball Bivd., Tigard, OR 97223 503.598.196 P1li R Date/By: V VIM Permit No.: P l'L 609.0034 O
Phone: 503.639.4171 Fax: .. 1 T u r TIGARD Pl ilt�vieW
B UILDING DIVISIO ' any:
Inspection Line 503,639 otherPeral " " °.:
T I t . `i(D .4175 Bale Ready/By: r •Internet: www.tigard-or.gov
See Page 1 for
NotifredfMethod: Col Information
T YPE OF WORD'."
Su � lemon
-- -- F>41+" 3Ci3EDUIE. .
El New construction ❑ Demolition 4 Fors, • cialln urination use checklist
Descri . hen « Ea, Total
Addihan/alt era 10 rep acemcnt
❑ Other New 1. 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF' CONSTRUCTION SFR (1) bath 312.70
al- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath - 437.78
❑ Accessory building El Multi-family SPR (3) bath 500.32
❑ Mager builder ❑ Other.;_. Each additional bath/kitchen 25.02
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION ANDS LOCATION Site utilities:
Job site address: 9 )-St) 5 �h Catch basin or area drain 18.76 ill City/State/2TP: 1 , Lt r 0 (z-- 61 --1 Drywcll, leach line, or trench dram 18.76
Suite/bldg./apt. no.: /� Footing drain (no. linear ft,: . ) Page 2
Project name; V e y Manufactured home utilities 50,03
Cross street/directions to job situ: Manholes 18 76
\(\--• s.,.
C ' J Rain drain connector 18.76 lin
v S S / Sanitary sewer (no. linear R.: ) Pag 2
In Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: SID ) 1 Page 2 (0,?, 5'
Subdivision: 1-,ot no.: Fixture or !tem:
Tax map /parcel no.: Backflow preventer 3127
DSCItIPTION .OF WORK 13ackwarer valve 12.51
' ..... ... . . ._ . .
Clothes washer 25,02
.: ..
L .0.: t - ' ` - k A.-= -' Dishwasher - 25.02 -
A r y\'`- .. --1-, 4-0 LA4 2 Drinking fountain 25.02 IM
Ejectors/sump 25,02
, 0 PROPERTY + QWNER � a , ,TE Expansion tank
, ,;. . , :,.. 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02 III
City /State/ZIP; 1
Garbage disposal 25.02
(lose bib 25.02
Phone ( ) r Fax ( )
Ice maker 12.51
0 "'APPLICANT ±` , s ?wr la'v `C904,CT,P)fSRSON Interceptor /grease trap 25,02
• Medical gas (value: $ ) page 2 •
Contact name: _ Primer 12.51
Ell
Address:
Roof drain (commercial) 12.51
Sink/basin/lavatory 25.02
City/5tatcIZIP: Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub /shower /showcr pan 12.51
E -mail: Urinal __ 25.02
CONTRAtPQIQ Water closet 25.02
Water heater 37.52
Business name: 1 el E e) U : r�
Address: �� Y1ti r Waterpiping/DWV 56.29
�' , D a4.. 5 i dl. Other; 25.02
City /State /2IP: yv 0 o L J Subtotal
Phone: (f )3) ( ' � , Fax: ( 5-t)) ( 1 -1 --71 1 Minimum permit fee: $72.50 -p
IMMI Plumbing Lic. no.: 6 (78 Plan review (25% of permit fcc)
-
State surcharge (12% of permit fee) 5 0
Authori2ed signatu 7 /1 LG� TOTAL PERMIT FEE
ram
Print name: � �, j , 1 Date: �� r 1 rj TM permit application explrea .(a permit is not obtained witEln! 80 dRya
�- - ale 0 � `F after It has been accepted as complete.
'Fee methodology set by Tri.County Building Industry Service Board,
f:\ Building \PennilaILMU•PermiiApp.d0C 10/01/09 440- 1616T(10/0740M/WEB)