Permit CITY OF TIGARD PLUMBING PERMIT
' - s COMMUNITY DEVELOPMENT Permit #: PLM2010 -00308
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/22/2010
Parcel: 2S 103DA03600
Jurisdiction: Tigard
Site address: 10855 SW PARK ST
Subdivision: Lot: 0
Project: Fagan
Project Description: Repipe whole residential dwelling
Owner: FEES
FAGAN, JOHN M AND PATRICIA L Quantity Description Date Amount
10855 SW PARK ST
TIGARD, OR 97223 1 ea Clothes Washer 09/22/2010 $25.02
1 ea Dishwasher 09/22/2010 $25.02
PHONE: 1 ea Sink 09/22/2010 $25.02
2 ea Lavatories 09/22/2010 $50.04
Contractor: 2 ea Tub /Shower /Shower Pan 09/22/2010 $25.02
BRUNER PLUMBING 2 ea Urinal 09/22/2010 $50.04
PO BOX 23985 1 ea Water Heater 09/22/2010 $37.52
TIGARD, OR 97281 1 12% State Surcharge - 09/22/2010 $28.52
PHONE: 503 - 624 -4880 Plumbing
FAX: 503 - 624 -2173
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $266.20
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: e7 Permittee Signature:
0/11 /9-/)/3‘.... C C /
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Call 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.
SEP -20 -2010 08:34F FROM:BRUNER PLUMBING 5036242173 TO: 5035981960 P.1
Plumbing Permit Application
Building Fixtures RE CEIVE:r FoR OPTIC .1 1151•: UN1.1
1111 • City of Tigard Receive Q /0 , PL/y,2ij /0 - o03ae
1.2 / Pe rmit No.:
13125 SW Hell Blvd., Tigard, OR 97223 S E P 1 2010 Plan Review /
• Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGARD r
I` WARD Data Read / sy: Juris. 0 Sec Page 1 for
Internet: www.tigard- orgov BUILDING DIVISION Notified/Method: 1 (j Supplemental Information
. • TYPE OF WORK . FEE' SCHEDULE
❑ New construction ❑ Demolition For special iryfornrarlon use checklist
Description 1 Qty. 1 Ea. 1 Total
Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
• CATEGORY OF CONSTRUCTION • SFR (1) bath 312.70
- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other. Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 g 55 S IN p A k e c ...4._ c ...4._ Catch basin or area drain 18.76
City/State/ZIP: • ^ � p ^ 7 Drywell, leach line, or trench dram 18.76 ftp f "` 1 lJ r� 6 7- Footing drain (no. linear Il.: _) Page 2
Suite/bldg. /apt. no.: Project name:
tun,- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76 I
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Pagc 2
Water service (no. linear ft.: ___) Page 2
Subdivision: l Lot no.: Fixture or item:
Tax map /parcel no.: Backftow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
• Clothes washer v 1 25.02 a5t v�
pc (.00-k.) w k0ak. .A,i 5 Dishwasher I 25.02 o z. _
Drinking fountain 25.02
Ejectors /sump 25.02
0 PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name: f-A - JO ii-/J #-Ta. L t (4. Fixture/sewer cap 25.02
O if 5 � Floor drain /floor sink /hub 25.02
`
Address: l 5 S43 a Garbage disposal 25.02
City /State/ZIP: -r( 6-s2 0 9 7 a 3 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51 i
0 APPLICANT ' _ • • '❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name:
Primer 12.51
Roof drain (commercial) 12.51
Address:
Sink/basin/lavatory ( 5 t y (, J . `.- 25.02 '7 , p
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub /shower /shower pan al e 7 12.51 s Vp
E -mail: Urinal 25.02
Water closet ✓ �2. 25.02 ,= 3,
CONTRACTOR 37.52 ' T S p
Water heater
Business name: C 4 4 , 4,,/;41‘ / -- . Water piping/DWV 56.29
/n
Address: U , t z.....3 C78s Other: 25.02 _ t _ ... 4.37. 61
City /State/ZIP: 77-- Subtotal
Phone: (50,1) 6 2., ({ t � Fax: 5,3 ) a.L - 2,1 73 Minimum permit fcc: $72.50
1 ,y
Plan review (25% of permit fee) a,, 52.
.f/rCCB Lic.: ' '3 - 7 Plumbing Lic. no.: 24 - Sr�PLS7
6 � State surcharge (12% of permit fee) c
Authorized signature TOTAL PERMIT FEE t�
Print name: !� v N//d1.Qn/ Date: q r a 0 , 1 This permit application expires If a permit is not obtained wild n 180 days
�'l after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board..
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