Permit --- CITY OF TIGARD PLUMBING PERMIT
t , COMMUNITY DEVELOPMENT Permit #: PLM2010 -00271
'13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/19/2010
T 1 GARD Parcel: 2S104AA90311
Jurisdiction: Tigard
Site address: 12646 SW KAREN ST 31
Subdivision: Lot: 0
Project: Bellwood Terrace
Project Description: Install (2) washer boxes in units 31 & 32.
Owner: FEES
BELLWOOD TERRACE LLC Quantity Description Date Amount
PO BOX 189 2 ea Clothes Washer 08/19/2010 $50.04
YAMHILL, OR 97148
1 12% State Surcharge - 08/19/2010 $8.70
PHONE: Plumbing
22 ea Minimum Fee Adjustment - 08/19/2010 $22.46
Plumbing
Contractor:
PRO DRAIN & ROOTER SERVICE, INC
3300 NW 185TH AVE #213
PORTLAND, OR 97229
PHONE: 503 - 533 -0430
FAX: 503 - 533 -9376
Type of Use: MF
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 �Y " Permittee Signature: eiA PL e f�� p �
���///IIIYYY " 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.
Aug 17 10 10:09a p - 1
Plumbing Permit Application
Site Utilities ,� , yY ``. FOR OFFICE �'SE ONLY
City Of Tigard n Nl i Re«
U G 1 rl By: o A0 / ._. Permit No.PL,/y D 0a/ 7/
11 14 • 13125 SW Hall Blvd., Tigard, OR 97223 A 1 Plan Review
o /O /
B Phone: 503.639.4171 Fax: 503.598.1960 t' Other Permit No.: • r t(Z�i•ttt)atelBy:
Inspection Line: 503.639.4175 \' O'f 9 ' ` - Da t4 Ready /By: .17,.......-21 See Page 2 for
'! r1,Gr \F. D: g b nd -orgov --. ,,t r�,�' t�l C
Internet: www.ti ,t; r A ! 1 + - IN'otified/Method: Supptementallotorma
TYPE OF WORK Ol�r�� t FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. + Ea. 1 Total
A Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building Multi- family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other, Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: l -a(Qy {O `7k., ' \ oye )r \ Catch basin or area drain 16.60
City/State /ZIP: ! t Y ( }a Q1 q " Drywell, leach line, or trench drain 16.60
`� + Footing drain (no. linear ft.: ) Page 2
r Suite/bldg. /apt. no.: i} roject name: , woo b �7 /u} C �
W t ` Manufactured home utilities 110.00
#5 r Cross street/directions to job site: Manholes 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 ft.: __,) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow prcventer Page 2
y)01-(306 .ii Q K 1t'1 Li >n r --rs Backwater valve 16.60
(� �� c _ , ' \ ~� l,(_ „ Clothes washer , 16.60 3,3, ,g()
1 CAI NS Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER L 0 TENANT Ejectors/sump 16.60
Name: Expansion tank 16.60
Address:
Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) I Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/Z1 P: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) 1 Fax : : ( ) 16.60
Tub /shower /shower pan
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60 Q
Business name (PY(-, o a-- \C cAb '& � CQ Water heater 16.60
Address: -� a + a1 Other
i ? �3 ^�!� t �� ! Subtotal 3 - 3 • aO
City/State /ZIP.rP (� 1� OV.- - q aa� Minimum permit fee: $72.50
Phone: "65' - . ("-) �} Fax: ($t: j) 53?) • ") "51 (a _ Residential backflow minimum permit fee: $36.25 i
P lumbin Lic. no.: Plan review (25 %ofpermit fee)
CCB Lic.: 101
l urc ,s q y g a 6, - 1 � P State surcharge (12% of permit fee) � , �0
Authorized signal ll 7 / / / " TOTAL PERMl "f FEE a �� /y� Date: _" - ' This permit application expires if a permit is not obtained within
Print name: f le 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.