Permit Y CITY OF TIGARD PLUMBING PERMIT
a k. COMMUNITY DEVELOPMENT Permit #: PLM2010 -00248
x N , Date Issued: 07/29/2010
;T I GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S111 D614200
Jurisdiction: Tigard
Site address: 15130 SW 92ND AVE
Subdivision: LAUNALYNDA PARK Lot: 29
Project: Diaz
Project Description: Replace 50' of water service. NOTE: elecrical permit maybe required if replacement piping
effects house grounding.
Owner: FEES
DIAZ, JEAN Quantity Description Date Amount
65 -1692 KOHALA MTN RD
KAMUELA, HI 96743 50 If Water Service 07/29/2010 $62.54
PHONE: 808-936-2726 1 12% State Surcharge - 07/29/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 07/29/2010 $9.96
Contractor: Plumbing
MR ROOTER PLUMBING
PO BOX 789
GLADSTONE, OR 97027
PHONE: 503 - 653 -5301
FAX: 503- 653 -5376
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 ■ . ification • • -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di -ct questions to 0 by c. '.g 503.246.6699 or 1.800.332.2344. 00.332.2344.
lss ed By: l /G/ /v /C C QQQCCClll���lll �rLL / Permittee Signat ,___
( . . 11 r 6 l :.0- - --,
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.
Jul. 27. 2010 7 :41AM No. 2673 P. 2
Plumbing Permit Applicat'
Building Fixtures CEEB , I OIl i 1(1 (I 1 I ONIV "
fi ? Received
City of Tigard 2 7 nalelDy: 7 A9 io ,�.h Perm ;t xn.: �Naolo -t9D a
f 4 13125 SW Hall Blvd., Tigard, OR 9 L a 10 Plan Review
_?' ' Phone: 503.6394171 Fax: 50 � Olher Permit No.:
Inspection Line: 503.639.4175 ' Dat OF TIGAR Date Rea ro Ur el see Page ater
l l, Vl Beady /fly:
Inte www "ligard- Or•gOV BUILDING I �i�I' ION Nolined/Meihod: Supplcd.eulal Yotormolian
TYPE OF WORK FEE* SCHEDULE
❑ New eonslruetion ❑ Demolition _ Forspeclal Information use checklist:
Description 1 Qty. i Pa. 1 Total
( ' Addition/alteration/reptacement ❑ Other: New 1- 2- family dwellings (includes 10011. for each utility connection)
f CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
)41- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
D Accessory building ❑ Muhi•fatnily
Each additional ba11m/kilchen 25.02
❑ Master builder ❑ Other: Fire sprinkler I_ sq. 11.) Page 2
JOB SITE INFORMATION AND LOIATION Site utilities:
,r
Job site address: I . 1� otl Catch basin or arca drain 18.76
City /Slate /ZIP: Z� Drywcll, leach line, or Ircnch drain 18.76
Footing drain (no. linear IL: ) Page 2
Suite/bldg" /apL no.: I Project name: Manufactured home utilities 50.03
Cross slrecUdirecliolns to job site: Manholes 18.76
rJt.) � t 1 Rain drain connector _ _18.76
rJ� �tit� Sanitary sewer (no. linear f1.: ____.) Page 2
Sloan sewer (no linear ft.: ) Page 2
Wafer service (no. linear R.: )) 1 Page 2
Subdivision: 1 Lot no.: Fixture Or item:
fax mop /parcel no.: Baekflow prevenler 31.27
DESCRIPTION OF WORK Backwater valve 12.51
-_ r Clothes washer 25.02
f \_ .', =•�� "/ 4 lX_ , • •
Dishwasher 25.02
Drinking fountain _ 25.02
Ejectors/sump 25.02
P)E17TY 0 ❑ TENANT Expansion tank 12.51
"JUN Fixture/se+xer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: Wit) q Fax: ( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor /grease trap 25.02
Business name: 1'4 r_ c p `i,L. Medical gas (value: $ _) Page 2
Primer 12.51
Contact name: y�
e�`� �14JUOr Roof drain (commercial) 12.51
Address; '/. 1 /, ! 2- O 1 Sink/ basinRevatory 25.02
City /State/ZIP: 7 I A O r - D Solar units (potable water) 62.54
Phone: (91 (p 5 ), ` Fax:: ( ) Tub /shower /shower pan 12.51
E -mail Urinal 25.02
CONTRACTOR Water closet 25.02
Water healer 37.52
Businessnamc, 3 `V m VAIA,b+ ` Waterpiping/DWV 56.29
Address: " Other: 25.02
City/Stale/ZIP: It(ei , on„ x"3627 Subtotal
Phone: P) (eC. - , k Fax: ( ) 605,3 -43 , Minimum permit fee: $72"50 72, e )
CCB Lie.: 1 Nict Li 3 Plumbing Lic. nor, 4' _ Plan review (25% of penult fee) 9.7
Slate surcharge (12% of permit fee) /1
Authorized signature: 4 44 /JJfI p' / TOTAL PERMIT FEE J 21 .,9•0
Print name: / I r 1 Date: C 7- 94r ' `t Thi permit application expires if o permit R not obtained within 180 days
alter it has been noeepled as complete
'Fee methodo►ogY set by Tri•Counly Building Industry Service Board.
I: 1Building \PefmitAPL1111- PKMi:ADp•doc 10/01!09 4404616T(IO/OZ/COMMan)