Permit iM044m q CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Permit #: PLM2009 -00306
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 10/23/2009
u�_vaa„ Parcel: 2S111AB01500
Jurisdiction: Tigard
Site address: 9170 SW ELROSE CT
Subdivision: Lot: 0
Project: Craven
Project Description: Connect existing SF to sewer.
Owner: FEES
CRAVEN, RICHARD EARL & Quantity Description Date Amount
MARY NAN, 9170 SW ELROSE CT
TIGARD, OR 97224 100 If Sewer Service 10/23/2009 $62.54
1 12% State Surcharge - 10/23/2009 $8.70
PHONE: Plumbing
10 ea Minimum Fee Adjustment - 10/23/2009 $9.96
Contractor: Plumbing
J & C EXCAVATING INC
39590 GARY ST
SANDY, OR 97055 -7316
PHONE: 503 - 318 -8075
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: Permittee 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.
Plumbing Permit Application
l V E
O CT I 2 3 2009 Received
City of Tigard a-A Permit No.: D= 13y:
q 13125 SW Hall Blvd.. Tigard, OR 97223 r~ Bv: ~
s Phone: 503.639.4171 Fax: 503.598. OF TIGARD Plan Review Other Permit No.: DateBy: w ,•V % 1!7
Inspection Line: 503.639.4175 fBy-
~1 P, ~
interne!: www.ti d-or. ov ~3 L7UlLD~I~G DIVISION Date Reed lu's: ®See Page 2 for
~ g Notified/M etho ethod: Supplemental Information
TYP Oh li'ORTC t - TEE`: 3HhDfE
C] New construction ~ ❑ Demolition Forspecial !n amwdonasechecklrst
Description Ea. Total
❑ Addiiion/alteration!replacement Q Other: New i- 2-family dwellings (includes 10011. for each utility connection)
C ~ll?C()RI ,OA CONSIRU~£ION Y SFR(1)bath 249.20
❑ i -and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ~ Mulli-family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath/kitchen 45.00
_ Fire sprinkler sq. ft.) Page 2
30IT.jSf f F'IiVFUYt1~7 fU:71lVDi:# fICA~J]6iV=:= Site utilities
Job site address: , i Catch basin or area drain 1 16.60
Citv!Stote/ZiP: f i7 ~ r ' Drywell, leach line, or trench drain 16.60
Project name: Footing drain {no. linear ft : Page 2
Suite/bidglapt, no
Manufactured home utilities I 110.00
Cross street/directions to job site Manholes 16.60
0 4
G Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 6 Page 2
Storm sever (no. linear ft.: Page 2
Subdivision: Lot no.: j eater smice (no. linear ft.: Page 2
Fixture or item
Tax map/parcel no.: r~
{ Absorption valve 16.60
a TfESGftii'N OT WORk k
- _z•. ~ Backftow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
r € ROP>uTt1'k.`bW ~xj 1Ez~?A1NT _.i,,;= Dr inking fountain 16.60
Ejectors/sump 16.60
Name: leExpansion tank 16.60
Address: U,' f ?6' Fixtureisewer cap 16.60
City/Stnte/ZIP: _ j j ✓ v Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone:( ) r Fax:{ )
[]I')QI.ICAfV F;z ;rmAF 1 E[iSf11V Hose bib 16.60
q .b lee maker 16.60
Business name:
Intercepror!greaselrap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City!State2IY: Roof drain (commercial) 16.60
( ) Fax:: ( ) Sink/basin/iavatory 16.60
Phone:
Tub/shower!shower pan 16.60
E-mail: Urinal 16.60
G01TRtiLxQk Water closet 16.60
Business name: Water heater 16.60
Address: Other:
Subtotal
City/5tate/7_iP:
Minimum permit fee: $72.50
Phone: (f ) Fax:( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: lww" 10• Z5 • ~ Yhunbing Lie. no.: Plan review (259'0 of permit fee)
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: ` ate: d + f Q q This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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