Permit CITY OF TIGARD PLUMBING PERMIT
' ' l COMMUNITY DEVELOPMENT Permit #: PLM2010 -00283
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 2S102BC01400
Jurisdiction: Tigard
Site address: 10250 SW WALNUT ST
Subdivision: Lot: 0
Project: Frazee
Project Description: Replace water service, water heater and water supply lines
Owner: FEES
FRAZEE, JOHN & NOREEN Quantity Description Date Amount
10250 SW WALNUT ST
TIGARD, OR 97223 50 If Water Service 08/26/2010 $62.54
1 ea Water Piping /DWV 08/26/2010 $56.29
PHONE: 1 ea Water Heater 08/26/2010 $37.52
1 12% State Surcharge - 08/26/2010 $18.76
Contractor: Plumbing
AGENT PLUMBING, INC.
14504 SW FERN ST
TIGARD, OR 97223
PHONE: 503 - 579 -3132
FAX:
9 7/- aso -o?5 ff
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $175.11
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:
./k/ � /)/611-. / e - v �„ /
"`CCC CaII 503.639.4175 by 7:00 a.m. for an Inspection that business day.
' v
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 2410 12:22p Agent Plumbing Inc 971 -250 -2568 p.1
Plumbing Permit Application 1 �. \
Site Utilities � "- ' 1 FOR OFFICE 1.81: ONL1
� ''
11 City of Tigard . Received �Ie Permit No.: L DD
• 13125 SW Hall Blvd., Tigard, ORC9 23: &(,
� .�
� . ,� Plae Review
I= Phone: 503.639.4171 Fax: 503.5 .1960 , > 7ueB Other Permit No.:
Jn spectio m Line: 503.639.4175 P\� y i r 0%
T I G A R D Z v. , Date Ready(By: lure: ei See Page 2 for
Internet: www.tigard- or.gov ;- : ,.,�\ � ' Not_6ediMethod: T,=(.0 r Supplemental Informat oo
TYPE OF WORK (`,W�,C; FEE* SCHEDULE
❑ New construction ❑ Del lit1On For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
El Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
21 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building 0 Multi- family
Each additional bath/kitchen 25.02
❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Page 2 _
JOB SITE INFORMATION AND LOCATION Site utilities:
I lob site address: 10250 SW Walnut Catch basin or area drain 18.76
Drywell, leach tine, or trench drain 18.76
City / State/ZIP: Tigard, OR 97223
Footing drain (no. linear ft.: ) Page 2
Suite/bldgJapt. no_: Project name: John & Noreen Frazee Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear 11.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear fl: I Page 2 62.54
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backtlow prcvcnter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replace water supply in house Dishwasher 25.02
1
Replace water beater Drinking fountain 25.02
Replace water service Ejectors/sump 25.02
01 PROPERTY OWNER f ❑ TENANT Expansion tank 12.51
Name: John & Noreen Frazee Fixture/sewer cap 25.02
Floor drain/floor sink'hub 25.02
Address: 10250 SW Walnut ....
Garbage disposal 25.02
City / State.2IP: Tigard, OR 97223 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Agent Plumbing Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Steve Moon
Roof drain (commercial) 12.51
Address: 14504 SW Fern Street Sink/basin,7avatory 25.02
City/State /ZIP: Tigard, OR 97223 Solar units (potable eater) 62.54
i Phone: (503) 579 -3132 Fax: : (971) 250 -2568 Tub/shower /shower pan 12.51
E -mail: steve@agenlplumbing.com Urinal 25.02
Water closet 25.02
CONTRACTOR -
Water heater 1 37.52 37.52
Business name: Agent Plumbing Water piping/DWV 1 1 56.29 56.29
Address: 14504 SW Fern Street Other: 25.02
City /State/ZIP: Tigard, OR 97223
Phone: (503) 579-3132 Fax: (971) 250 -2568
Subtotal 156.35
1\1„j Minimum permit fee: $ 72.50 ermit fee)
CCB 1.ic.: (78492 Plumbing Lic. no.: PB348 tA__________ Plan review (25% of p
State surcharge (12% of permit fee) 18.76
Authorized signature: I TOTAL PERMIT FEE 175. I 1 ....'"•....
Print name: Steve Moon I Date: 824/2019 This permit applicadon expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology sct by Tri- County Building Industry Service Board.
1:41ui :dineermilaLMU- PennirApp.doc IOg1.09 4401616T(10;02/COMAVEO)