Permit CITY OF TIGARD PLUMBING PERMIT
' • = `- COMMUNITY DEVELOPMENT Permit #: PLM2010 -00279
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2010
Parcel: 1S125DA07600
Jurisdiction: Tigard
Site address: 9295 SW 69TH AVE
Subdivision: KINGS VIEW Lot: 77
Project: Deibele
Project Description: Replace 40' of kitchen sink drain line
Owner: FEES
DEIBELE, DIANE Quantity Description Date Amount
9295 SW 69TH AVE
TIGARD, OR 97223 1 ea Water Piping /DWV 08/25/2010 $56.29
PHONE: 503 246 -8026 1 12% State Surcharge - 08/25/2010 $8.70
Plumbing
16 ea Minimum Fee Adjustment - 08/25/2010 $16.21
Contractor: Plumbing
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503 - 239 -8801
FAX: 503 -669 -9568
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: //11 /71 /
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. 23. 2010 3:33PM No, 2936 P. 1
Plumbing Permit Application _ ,
Building Fixtures FOR OFFIC'L USE ONLY
City of Tigard � Received
g / I I Date/D y /o etml N o. : q
p 13125 SW Hall Blvd., Tigard, OR 97 G 2 4 2010 � �/ Z � Pi �a20�� �D0�7�
• i Phone: 503.639.4171 Fax: 503.598.1960
Plea Review Other Permit No.:
Date/9y;
T I G ARD Inspection Line: 503.639.4I75 Date Ready/ y: ru .: 65 See Page b for
Internet www,tigard- or.gov Notified/Method: Supplemental Information
' TYPE' OF WORK ::: - FEE' SCHEDIILE
❑ New construction ❑ Demolition For special irt(brnratfon use checklist:
ger.' Description 1 Qty. 1 Ea. 1 Total
r - # dition/altcration/replacement ❑ Other; New I.2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312,70
� and 2-family rttil dwelling SFR (2) bath 437.78
y g ❑ Commercial/industrial
SFR (3) bath 500,32
❑ Accessory building ❑ Multi - family
Each additional both/kitchen 25.02
['Master builder ❑ Other:
• Fire sprinkler ( sq. fl.) Page 2
! JOB SITE INFORMATION AND LOCATION ::, .:. Site utllltles:
Job site address: ! q5 '51,0 Co9 PVC Catch basin or area drain 18.76
Drywell, leach line, or french drain 18.76
City/Slate /ZIP: a i I • • Fooling drain (no. linear fl,: _) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear fl.: ) Page 2
Water service (no. linear ft.: ) Page 2 _
Subdivision: Lot no.; Fixture or item:
•
Tax map /parcel no.: Backflow preventer 31.27 _
, . ...... . •
. kwater valve 12.51
Bac
D�SCRIPTION:OF'WORIC '
L.�� t ...... , ,. f � •....... ..... Clothes washer 25,02
� ,1_ /01 O k- A- 4 -h Dishwasher 25.02
UYI a.i/1A- (.4/KA- - Drinking fountain 25.02
Ejectors /sump 25.02
? 1?rOPERTY OWNER .:. ::: ❑. TENANT::: Expansion tank 12.51
•
Name: (G , EA_ cap 25.02
Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone:) G - Fax: ( ) Ice maker w 12.51
:::::.:::;.•
if 'PPLICANT ::❑ CONTACT PERSON, 1ntereeplor /grease trap 25.02
Business name: i - Medical gas (value: $ ` ) Page 2
f
Contact name: Primer 12,51
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax; : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
... CONTRACTOR Water c se
-
Water heater 37.52
Business name: • /70 .V 0,e0 / - Water piping/DWV -7 56.29
Address: J : ' .4 ' ._d /1 / Ile Other. 25.02
City /State/ZIP: A 4 , Ot q7 0 Subtotal
Phone: (" // �� - , , Fax: (6 60( 9 tFe)07E - Minimum permit fee: $72.50 7a , s a
Plan review (25% of permit fee)
CCB Lic.: q l Plumbing Lic. no.: �,�,.J �J State surcharge (12% of permit fco)
Authorized signa e 70
_ TOTAL PERMIT FEE f p/. „zo ,/
Print name; ,, , Date /�3 a Tats permit appl expires If a permit Is not obtained within 180 days
�i ru l �L1 � .' after 11 has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board,
I: 1BuildingPermiiMhtU .PermirApp.dco 10/01/09 440.4616T(10l07/COvjM6)