Permit CITY OF TIGAR® PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00053
T E GARB 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/19/2010
Parcel: 2S111 DC01700
Jurisdiction: Tigard
Site address: 15945 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 464
Project: Denney
Project Description: Relocate washing machine and water heater to garage.
Owner: FEES
DENNEY Quantity Description Date Amount
15945 SW ALDERBROOK CIR
TIGARD, OR 97224 1 ea Clothes Washer 02/19/2010 $25.02
1 ea Water Heater 02/19/2010 $37.52
PHONE: 10 ea Minimum Fee Adjustment - 02/19/2010 $9.96
Plumbing
Contractor: 1 12% State Surcharge - 02/19/2010 $8.70
ANCTIL PLUMBING INC. Plumbing
16900 SW MERLO ROAD
BEAVERTON, OR 97006 -0000
PHONE: 503 - 642 -7323
FAX: 503- 642 -7755
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ica ionC- ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or rect questions to • N • calling 503.246.6699 or 1.800.332.2344.
lss ed By: 0 � Permittee Signa re: � O ( ,
/ �i
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicat a r q °" • r e m '2-.9)J" viz_ �
• Building Fixtures _ ,- ;4' � 'I:L)R 0 f!,1 - .1(.:110.:S L, O l� . i
City FE B 1 2010 .i �,.�. -Mr' x , P .4 ` � °.
�r ty of Tigard Real ed
Ihte B : / il ParzUrt No P
■ 13125 S W Ball Blvd., Tigard, OR 97223 ' ■ O O "IMO
. . Z Phone: 503.639.4171 Fax: 503.598.11@p-1.Y OF ; !GARD Da y: ew Other Permit No,:
r ^ i � .. Inspect Line: 503.639.4175 DIVISION
T ;sis t BUILDING Nori0e0/Mot o Juris: 6� See Pa a 2 for
�$fc u :•.;•Sr r . Internet: www,tigard- or.gov NoiifaeQ/Mpthod: 1 _ ' S .lem tn to rmason
TYPE OF WORK FEE* SCHEDULE
❑ New construction fl Demolition For special information use checklist
Descri +non • , ' Ea. Total
e dition/alteratiou/replacement ❑ Other: I New 1- 2-family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION ' SFR (1) bath NM 249.20
rat- and 2- family dwelling Q Commercial/industriai SFR (2) bath ME 350.00
■ Accessory building • ❑ Multi - family SFR (3) bath 399.00 10
Q Master builder ❑ Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Job site address: 1 5+ Lj 5 Std L # - i ✓ Co , Catch basin or area drain 16,60
City /State/Zit Gig-C- C Drywell, leach line, or trench drain 16.60 1
I
Suite/bldg. /apt. no.: Project name: E i Footing drain (no. linear ft.: ) impnii
Coss street/directions to job site; Manufactured home utilities 110.00
Manholes NM 16.60
Rain drain connector 16.60
Sanitary sewer (no, linear ft.: .) Page 2
Storm sewer (no. linear ft.: - _) Page 2
Subdivision: Lot no.: Water service (no. linear t: _ )
Tax map/parcel no.:
Fixture or item
Absorption valve 16.60
DESCRXPTION OF WORK Backflow prevent= 1111111 Page 2
_.. `-. g� CA t A I:0k MAC H.% , 4 Backwater valve- In 16.60 NM
1( ANWAIAW____Vt_trIECISE Clothes washer II' 16.60 .
• E Dishwasher 16.60
n• PROPERTY 0 ., R 0 0 TENANT Drinking fountain 16.60
Name; , N Ejcctora /sump 16.60 EMI
Expansion tank 16.60
Address: Fixturelsewcr cap 16.60 MEI
City/State /ZIP: Floor drain/floor sink/hub 16.60
Phone; ( ) Fax; ( ) Garbage disposal , 16.60
L 0 APPLICANT 0 CONTACT PER Hose bib - 16.60
- Business name: Ice maker 1.11 16 SIM
1111 Interceptorlgrcasetrap IIII. 16 MIMI
Contact name: .- name: Medical gas (value: $ ) Page 2
Address: Z010
Primer ME 16.60
City/State/ZIP: I■ Roof drain (commercial) ME 16.60
Phone: ( ) F Sink/basin/lavatory 16.60
E -mail:
Tub /shower /sktowcr pan 16.60
Urinal .. 1111 16.60
■� 16.60
CONTRACTOR water closet -
Business name: r N C I - L (/ice / i ► Water heater 16.60
Address: 0 a d IA-/ f 7) g ii l j j7 • Other: M IMIIIIIII
City /State /ZIP: r aw V E ■ A./ Q' • 0 _ Subtotal a
623 2 Minimum ermit fee: $72.50
, Phone: Z- .32.3 Fa ( 5b3 2_ 7q-SS. Residential backflow minimum permit fee: 536.25 1
CCB Lie.: 1 8 Plumbing Lic. .-i k;2. P ;, Plan review (25 % of perrnit fee)
Authorized signature: State surcharge (12% of permit fee) I1a
TOTAL PERMIT FEE MR
Print name: r ;U.- ' N �L_.,� C L Date: 24 e � 1 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology sot by Tri- County Building Industry Service Board.
l :\BuildinsWvmia,\pl,tva- Pecmitp doe 1ZN27 /0E
PP� 440 -0616T(10 /07JCQiN/VVt;H)
Plumbin Permit A licatio
Building Fixtures
RgY l fY~ ~K..
City of Tigard FEB 18 2010
y
t lC~ PmnutNa.: aZD O
13125 SW Hall Blvd., Tigard, OR 97223 I>aIan R ew
C Phone: 503.639.4171 Fax: 503.59g.118QT Or I IGARD Dare/B OtLerPermitNo,;
i" Inspection Line: $03.639.4175 y'
olteady/Ily: M SeePage 2for
a Internet: www,tigard-or.gov BUILDING DIVISION, Datef
NileQ/Mathod: ! ' sn t=catal1"formafion
TYPE OF WORK FEE* SCIMULE
❑ New construction El Demolition For eelal lttformatYon use ckeckllst
Des!E i Lion 1✓a Total
dition/alterffiiou/replacement ❑ Other: New 1- 2-family dwellings (includes 1,130 7 Qty'
ft for each utility connectim)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
- and 2-family dwelling i ❑ Commereial/industrial SFR (2) bath 350.00
Accessory building ❑ Multi-family SFR (3) bath 399.00
❑ Master builder ❑ Other, Each additional bath/kitchen 45.00
Fire sprinkler L . sq. ft.) Page 2
JO$ S)ET)tr INFORMATION AND LOCATION Site utilities
Job site address-. ' S Ll S SW A t Catch basin or area drain 16.60
City/State/Z1P: Drywell;, leach line, or trencb drain 16.60
SuitePoldg./apt. no.: Project name: Footing drain (no. linear ft.: Page 2
Goss 3treet/direclions to job site; Manufachired home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no, linear ft.: T Page 2
Storm sewer (no. Linear ft,: Page 2
Subdivision: Lot no.: Water service (no. linear ft.: Pagc 2
Fixture or item
Tax tnap/parccJ no.:
Absorption valve 16,60
DESCRIPTION OF WORK Backflow prevcnur page 2
jE_ V C Backwater valve 16,60
(AAO 1(JV'l r Clothes washer - 16.60
V EPN ~ Dishwasher 16.60
Drinking foumaiA 26.60
PROPERTY O R ❑ TENANT
Ejectors/sump 16.60
Name:
Expansion tank 16.60
Address: - Fixture/sewer cap 16.60
Ciry/State/zlP: Floor drain/floor sinidhub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
APPLICANT ❑ CONTACT MRSON Hose bib 16.60
Business naive: Ice maker 16.60
Interceptor/grease trap 16.60
Contact nano: Medical gas (value: $ ) Page 2
,Address: Primer mer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fa SUiVbasin/lavatory 16.60
Tab/shower/shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: l1 C L ! /J ^ f Water heater 16.60 1
Address: d o 1A ry] 9 LD AD• Other:
City/State/ZIP: ~E ~ f 6 pG Subtotal 3 .1- D
Minimum permit fee: $72.50
Phone: 5* (OYZ- _?-3Z3 Fax-, (Sb% Z- ?455' Residential backflow minin um permit fee: $36.25 ,
CCBLic.: $ Plumbing Lie: Plan review (25%0 fpermitfcc) Aar~
Authorized signature: State surcharge (12°b of permit fee)
TOTAL PERMIT FEE
Print Warne: ^/Lr j L Date: 2r pjj r 1 p 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.
T:lttuilding\Pvmits\?LNg.PermitApp.do 12x17/06 440.4616T(t0102/COM/wEE)
CITY OF TIGARD PLUMBING PERMIT
0 COMMUNITY DEVELOPMENT Permit#: PLM2010-00053
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/19/2010
Parcel: 2S111 DC01700
Jurisdiction: Tigard
Site address: 15945 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 464
Project: Denney
Project Description: Relocate washing machine and water heater to garage.
Owner: FEES
DENNEY Quantity Description Date Amount
15945 SW ALDERBROOK CIR
TIGARD, OR 97224 1 ea Clothes Washer 02/19/2010 $25.02
1 ea Water Heater 02/19/2010 $37.52
PHONE: 10 ea Minimum Fee Adjustment - 02/19/2010 $9.96
Plumbing
Contractor: 1 12% State Surcharge - 02/19/2010 $8.70
ANCTIL PLUMBING INC. Plumbing
16900 SW MERLO ROAD
BEAVERTON, OR 97006-0000
PHONE: 503-642-7323
FAX: 503-642-7755
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 ca ion-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 rect questions to N calling 503.246.6699 or 1.800.332.2344.
Iss ed By: Permittee Signa re:
c
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.