Permit CITY OF TIGARD PLUMBING PERMIT
e COMMUNITY DEVELOPMENT Permit #: PLM2010 -00312
T [GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2010
Parcel: 2S103CB08300 .
Jurisdiction: Tigard
Site address: 12373 SW QUAIL CREEK LN
Subdivision: Lot: 0
Project: Yuzon
Project Description: Solar hot water system.
Owner: FEES
YUZON, JASON B & KELSEY M Quantity Description Date Amount
12373 SW QUAIL CREEK LN
TIGARD, OR 97223 1 ea Solar Units (Potable 09/23/2010 $62.54
Water)
PHONE: 1 12% State Surcharge - 09/23/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 09/23/2010 $9.96
Contractor: Plumbing
PHONE:
FAX:
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. V
Issued By: .( Permittee Signature: E)
'447.C1--1- --
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. U
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.
Plumbing Permit Application
Building Fixtures ���
D I G n
Received / �
71 City of Tigard '3 ti� DateBy: '"1 }3 b Permit No.: Puhafllr)_ncr`3 f`1.
C n 13125 SW Hall Blvd., Tigard,OR 97223 c.g n plan Review
Phone: 503.639.4171 Fax: 503.598.1960 J •\� Date
By: Other Permit No.:
Inspection Line: 503.639.4175 o f \ S `� Q� ate Read luris. El See Page 2 for
1' R Internet: www.ti ardor. ov `I
g g GI r o\ C - Notified/Me --r Supplemental Information
TYPE OF WORK f2 a FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
E1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /Q37 3 SidQ4A / � C�,ijc LAME Catch basin or area drain 18.76
City /State /ZIP: •Ti 44 .D DA. • Drywell, leach line, or trench drain 18.76
9 7 a3 F oot i ng d rain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: [Project name: ' 1A Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1 LOT £,447 e F G°R N 1 1, 2 0 Q(4,41 L- cem Rain drain connector 18.76
14 N f a y ,� A �E • Sanitary sewer (no. linear ft.: _J Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�/ Clothes washer 25.02
So SF S0L.A/L. - Dom as- rW"r £ 1,4ICJt. Dishwasher 25.02
Sysrrom Drinking fountain 25.02
TANK&.h.SS 14ATgA H*,417 . lNSTy44.4.4TIowl Ejectors /sump 25.02
[PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap • 25.02
Name: 4A.164 AND Kai..4sy Slit z on/
Floor drain floor sink/hub 25.02
Address: / a 3 73 Sw q�� iL. Cd.LS . LANE
K�� Garbage disposal 25.02
City/State /ZIP: -T- 1 a • 9 7a a 3 Hose bib 25.02
Phone: (1 144 - 64 3$ Fax: ( ) Ice maker 12.51
❑ APPLICANT CONTACT PERSON Interceptor /grease trap 25.02
Business name: / mA4 /ME EK S/Q.4S / a 4.4..e., Medical gas (value: $ ) Pa 2
Primer 12.51
Contact name: TK.I574N Coo&.44
G Roof drain (commercial) 12.51
Address: N 31 /'1 • G e04.p wi tty 6r. Sink/basin/lavatory 25.02
City/State /ZIP: PbR,T4_RN1.b / co_ , q 7'P 7.7 Solar units (potable water) '' 62.54 G?,, 54
Phone: (603) 196, t✓ .. 74414/ Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: +. C.apl � �Q0, • «�,, *' Urinal 25.02
� /
+./ CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: hri44 /NE give.e.4 14 Lt.G • Water piping/DWV 56.29
Address: 1.43q N. g, / .5. Other: 25.02
City /State /ZIP: IbIL.TL- 4N4 Qg, q 7Z a,7 Subtotal
Phone: (603) q 7 7 - q Say Fax: (5C3) 4 177 - 83140 Minimum permit fee: $72.50 - 2 0 1,.5-0
CCB Lic.: /6716 1 �10/t. Plumbing Lic. no.: Pa 7 s Plan review (25% of permit fee)
State surcharge (12% of permit fee) O' 70
Authorized signature: 0 7 /l /l f TOTAL PERMIT FEE 6 1 j
Print name: 'TE, fS LACY Date: 9 /& 3 /l b This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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