Permit q CITY OF TIGAR PLUMBING PERMIT
ill a : COMMUNITY DEVELOPMENT Permit #: PLM2010 00273
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/24/2010
Parcel: 1S135DC01600
Jurisdiction: Tigard
Site address: 11780 SW 91ST AVE
Subdivision: TIGARDVILLE PARK Lot: 9
Project: CRUICKSHANK
Project Description: Replace 30' of water service.
Owner: FEES
CRUICKSHANK, LAURA J Quantity Description Date Amount
11780 SW 91ST AVE
TIGARD, OR 97223 30 If Water Service 08/24/2010 $62.54
PHONE: 1 12% State Surcharge - 08/24/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 08/24/2010 $9.96
Contractor: Plumbing
JACK CORMAN PLUMBING INC
7483 SE JOHNSON CREEK BLVD
PORTLAND, OR 97206
PHONE: 503 - 788 -6947
FAX: 503- 788 -6949
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 ques • to -OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B : , 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.
08/20/2010 15:52 5037886949 JACK CORMAN PLUMBING PAGE 02/02
Plumbing Permit ,Application
City w T xr i r » Blvd„ Tigard, OR 97223 Au� u U 20 1 Received AO /o A, . PermitNo,; (We/OW -.ow 7.
1 . Phone: 503,639.4171 Fax: 503.598.1960 • _ � w Other Permit No.;
Inspection Line: 503.639.4175 , Date Readyffiy: .testa: la See Page for
I t <1,% 1? 17 Internet: www.tigard- or.gov - Notified/Method; Supplemental Information
ra;n�, >s;�.N^ I '• .95e� ' . . : -q. ; A 51:. ; 1 -.av L' :,'4'fIL. ;'it'.
a! �l '11F^!'... ( :a - 1:; Y,;[.'.. �,'-�' '!�'b�: 0 '� :r h'�'; > 7 ' .,+.. i i., _ '�..
. %: r . ... - > �� F�' + �. r��ti ...,. -
��- �'. ' +h ��. .,., . ,.. ... �s ., P � .... ' . �: :. 'i " >'� I,. Lb sae 9 .�.. ° .., yr t�
0 New construction ❑ Demolition Fors f iu, rmadon use dreck Ss. Ea. 1 Total
❑ Other: New 1p2 fmully dwellhrgs (includes 1 R. Qty,
for I
Addition/alteration/rep o onnection)
Addition/alteration/replacement Cr' 17 utility o
='6 r.:�',;,...� AA ;': a ' , ' `r' '��� itiNW: '.I `
°;.. c SFR (l) bath 249,20
'M t I �IiI. ri J���'' Vr -TI-i (w�T'jJ.� Y::lf .. . E'..�. ..r'!:'II... .,,,• , _: .. , • a ,J
■.� 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath _ 350.00
El Accessory Wilding 0 Multi- family
SFR (3) bath 399.00
Each additional bath/kitchen 45,00
E. Master builder 0 Other: Firc sprinkler (_ sq. R,) Pag 2
I yN n'1 L:'f` �• 1YM VITA' �lYIY.S g r' k , %!;.'' -' . :' .-" :,
kl-..r � +: ..,. , , . �. ,.•: ;.:r � ... , , �•n. ''-'2, � !; � site utQttle
..,...:� w .
Job site address: I f K Q 5K-.)(10_ ! " A V Q _. Catoh basin or Area drain 16.60
City /State/ZIP: --1 , A ()rte „..„ Jhywell, leach line, or trench drain 16,60
Suite //bldg^ /apt no.: � Proj name:
Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _____) Pnge 2
Storm sewer (no. linear ft.: Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ,i Page 2
Fixture or Item
Tax map/parcel no.: Absorption valve 16.60
:: �i' w.Y ITg 'J!'Y.Y .,�.,:�; L� ., Ab �` x,L.• .
y `,.1,N _} �;. 1,w•. 4';. ,:.,4"• •t " '.'' .;:. 1; '.,. , ;:" _0 :4. ..'' 1, ' . :,. , ;! ,r Page 2.
1 .t ^n'I: .,r. � ,� r .
a hr , ` , - a l�scl[f1olVprCVCnter
I • ., ' i) 4 Cc Baokwater valve 16,60
Clothes washer 16,60
)[shwasber 16.60
;
; . ; .. M1 ., l ,,, ry y1}, y y�y'''' ^ °5':!;,:7it '"'" ::i''':�,;�;,'a,,;a- ,,. .y�oi :" 1
',,!'.i'^' Drinking fountain 16.60
j; � le. :i� a ,' a4'14 . " ti.r . : - 6'.! ',d, 7, < :.?.,,! • 'y', = .r�Pl ..`,'!,:i;f4.'�' +ac,i., i
.� >`.• u s #` j cctors/stunp 16.60
Name: Expansion tank _. 16.60
Address: Fixture/sewer oap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Garbage
Phone Fax: ( )
posal 16.60
disposal
( ) _. Jlosc bib 16,60
P,:',;, *r.:: {• .;:,.:Va M' y ,�p,(� ";�¢'�'-.'=el, "9(''. ` :':,; (�a'S�'.i.h '_fi tkOt`i'0tI'iLC`J�1`I'' .; ; ;,.:
MA W",, Y l'�1 : tl fi h� .S ;:h; 1CC ItlalCar 16.60
Business name: Interceptor/arm s° trap 16.60 ^
Contact name: Medical gas (value: $ ) Page 2
Address: Vim' 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16,60
Phone: ( ) 11?ax: ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
- ..::Lit,.1,. ::t?";hJ 0n:r.. 1., 1 i;'%Nt� PO1'tli1J'��;;+�.. ,a g; ` 4>''�`i. - .:;:iy; %',;r� Waterclosct 16.60
Business name' 1 f Y 1ld.�i `i N 1 ITLM Water heater 16.60
r
Address: ► . J ' 1 L • A C V mutter:
�t Subtotal
City /Statte/Z1P: r �,�L /, . b • - 1 _L.. Minimum permit fee: $72.50 ' i -5p
Phone: ') Fax: » ' Ft 9 Residential backflow minhnum_permit fcc: $36.25
Plan review (25% of permit fcc)
CO3 Lie.: / i dig" 'lambing Lies no.: _kei r ' r
State suroharg0 (1 % of permit fee) X ;19
Authorized signature: 4111.1r41.
4�T .r TOTAL PERMIT FEE j .' Q
j
Print name: t,� � &g ;t' Date: y. • 4 This pet,atit application expires if a permit is not obttlned within
,� J. r r 180 days artier It has heed accepted as complete.
*Fee methodology set by Tn- County Building Industry Service Board.
MUntline ,n a.�rr,naa+ec[ataan,nrP2 nau>/aa , rnaR, vrtrorovcoM >