Permit CITY OF TIGARD PLUMBING PERMIT
. 11 111 1 44
C COMMUNITY DEVELOPMENT Permit #: PLM2010 -00288
T i GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/31/2010
Parcel: 2S102CC01900
Jurisdiction: Tigard
Site address: 10225 SW HILLVIEW ST
Subdivision: Lot: 0
Project: Uphoff
Project Description: Replacing 100 ft. of water service. Electrical permit may be required if replacement piping affects
house grounding.
Owner: FEES
UPHOFF FAMILY TRUST Quantity Description Date Amount
BY RICHARD C /ELNOR A UPHOFF TRS, 10225
SW HILL VIEW ST 100 If Water Service 08/31/2010 $62.54
PHONE: 1 12% State Surcharge - 08/31/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 08/31/2010 $9.96
Contractor: Plumbing
PIPELINE PLUMBING
333 S STATE ST, STE. V -108
LAKE OSWEGO, OR 97034
PHONE: 503 - 624 -1906
FAX: 503 - 624 -1926
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:, r. Permittee Signature:
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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.
RECEIVED p.1
P lumbing Permit Application p LI G 3 1 2010
Building Fixtures
City of Tigard CITY OF TIGARD n s 31 f ii ) 3 7T � ` p ,1, 11, -orb
1, 1 3125 SW Hal Blvd.,Ti�e,oRl #�DI NGDIV[S1ON P,mmR / Other Pamir
Inspection Lin= 503.639.4175
Mom 503.639.4171 Fare 503598.1960 > � it SeePnge2mr
Date ReadYBr •�-�/
i 1 G:'.r: Ned: , ). - L { Supplemental
tntereet wvvw.tigatel•or.8'm'
TYPE OF WORK FEE* SCHEDULE
❑ Demolition For spaded inforniatian we checkras 1 Total Description l Qty. 1
Ili Aiod 0 Other: New 1- 2-family dwellings (includes 100 8 for each utility connection)
SFR (1) bulb 312.70 •
CATEGORY OF CONSTRUCTION SFR 1) bath 312.70
�1- and 2-family dwelling � SFR (3) bath 50032
❑ Accessary building ❑ Multi- family Each additional bath/kitchen • 25.02
0 Master builder 0 other. Fare sprinkler L-_ s4. it) Page 2
108 S1TE INFORMATION AND LOCATION Site ate:
ll �f � �j OF area 18.76
]ob site addres I a2Z5 ) l 1 V � i e »`-' lc'xt trench all, leach lint. or trench dome , 18.76
Cris /Sfo2 /Z1P:: 1 1 , y -8 t C G l ezZ?? Footing drain (no. linear 1t: _� Page 2
Suite/Mg/apt. no.: 1 Project nom L
: Lvino 50.03
Manholes 18.76
Manufactured home utilities
Cross street/directions to job site: 18.76
Rain drain aoema .
tor
Sanitary sewer (no. linear ft.: __J Page 2
Storm sewer (no. linear ft: __) Page 2
Water service (no. linear ft.: 4,011) j Page 2
Subdivision: 1 Lot no. F 31.27
Tax map/parcel no.: Backwater valve 12.51
pESCMYl'1ON OF WORK Ckdhes washer 25.02
- 1X l 1 25.02
111 'l 4. 1 �'t�" �l ( f) . Drinkingf 25.02
Ejectors/swop 25.02
1 ❑ IhNANw tank 12.51
El PROPERTY OWNER Fixture/sewer cap 25.02
Nance Floor drain/Boor sidolbub 25.02
Address: Garbage disposal 25.02
City/Stale/ZIP: Hose bib 25.02
Fax: ( ) 12.51
Phone: ( ) F Ice nalta
❑ CONTACT PERSON
Interceptor/grease trap 25
[] APF'1'ICAM Medical Bas (vainc S ) 2
Business rati ! � V A. (i P v, 0v..\ ,,N� _ 12.51
Prima Contact ninon Roof drain (commas:IC 12.51
Ades$:
Sii*Jbasinlavatory 25
Solar units (potable water) 62.54
City/State/ZIP: r 1251
Phone: ( ) 1 Fax: : ( ) _Tub/shawaishawapan
Urinal 25.02
E-mail: Water closet 25.02
,, \ CONTRACTOR Al ACC heater 37.52
Business n ? '10_.1�v\..so e � , ,' 0 1 \ Water piping/DWV 56.29
Address: -' 5 € �W c • PM f - L One 25.02
CitYIStateafP: LEA- Dersi ' (`_ ��V ?A 7� • Subtotal
r oe: sn.sa \ 9-) Phone: (Sib) l 0�-� � �bl n V Fa ac (��j) 1,p.2� -t �a'Z;LO {� Pan review fts %of permit fax) •
CCB Liu: 5e, p Plumbing Lic. no.: - 35 I (7 ` 1J State surcharge (12% of permit fee) r _"--7 J
t I OTAL PERMIT FEE in _ )∎ �l
Authorized si • T , �� This watt application expires der pesm not oEfaioad wie days
D ate: /4, L au.. n..iiwl,J tin l Gne� R•roie . growl Prins iiaat� � � t L,�, '' Qx 1( �c11n