Permit CITY OF TIGARD PLUMBING PERMIT
IIf COMMUNITY DEVELOPMENT Permit #: PLM2010 -00315
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2010
Parcel: 1 S 125CA08800
Jurisdiction: Tigard
Site address: 9235 SW 74TH AVE
Subdivision: ALL TOWN PROPERTIES PARTITION Lot: 2
Project: Hiatt
Project Description: Repiping first floor.
Owner: FEES
HIATT, LESLIE 0 & MELVA JOAN Quantity Description Date Amount
9235 SW 74TH AVE
TIGARD, OR 97223 1 ea Water Piping /DWV 09/30/2010 $56.29
PHONE: 1 12% State Surcharge - 09/30/2010 $8.70
Plumbing
16 ea Minimum Fee Adjustment - 09/30/2010 $16.21
Contractor: Plumbing
D & F PLUMBING
4636 N ALBINA AVE
PORTLAND, OR 97217
PHONE: 503 - 282 -0993
FAX: 503 - 288 -0604
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.
N
Issued By: - Permittee Signature: / �/
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.
Sep 28 10 09:01a D & F PLUMBING 503- 288 -0604 p.1
Plumbing Permit Application
Building Fixtures �+ ,► FOR OFFICE USE ONLY
City of Tigard O � Received �
• (312 SW Hall Blvd., Ti 01� Datc/By: Permit No.:
Tigard, OR 972.3 Plan Review f d r �/ /
Er Phone: 503.639.4171 Fax: 503.598.1961*Q 94 DateBy: Other Permit No.:
T I Ga RD Inspection Line: 503.639.4175 �lC} [ v' ` Dat Ready/By
Internet: www.tigard-or.gov
C1, 0� ' r � x /p Su ®Sec pplemenia[ Paee 2 for
ntion
Imto
,� J 0 NotiF.ed/Me hod: l
rm
TYPE OF WORK ul1� 1��� t FEE* SCHEDULE
El New construction ❑ t- of ition For special information use checklist.
1 Description I Qty. Ea. I Total
-Addition /alterationireplacement 0 Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath J 312.70
Ig 1 -and 2- family dwelling ❑ CommerciaVindus ria. SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ O ther: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: t�2 ?s , 74Q 4-7/F Catch basin or area drain 18 7b
City/State/ZIP: Drywell, leach line, or trench drain 13.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name:M 9-77 '
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 ft: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot nc.: Fixture or item:
Tax map/pareel no.: Backflow preventer 31.27
F DESCRIPTION OF WORK Badctvatervaha 12.51
/ Clothes washer 25.02
freer /�0 r Yee/0- Dishwasher 25.02
Pr- / PONdV Drinking fountain 25.02
q /3o 6 1 - - Ejectors/sump 25.02
PROPERTY OWNER ❑ TENT Expansion tank 12.51
Name: (. �i A. Fixture /sewer cap 25.02
Address: C.?f�'1'17
Floor drainifloorsinluhub 25.02
City /State/ZLP:
Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT P . a Interceptor /grease trap 25.02
Business name: Medical gas (value: S ) P age 2
Contact name: Primer 12.51
Address:
Roofdrain (commercial) 12.51
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 closet 25.02
r � Water heater
Business name: L p ,i 1l��� G 37.52
C Water piping/DWV 1 56.29
Address: 6 3 N ' , /i✓/ Other: 1 25.02
i
_ �� 4 Subtotal EISIMM
Phone: ( ) Z -�Z - 93 Fax: (P ) 7, -d. t 7 Minimum permit fee: 572.50 Os' 72...a.)
CCB Lic.: c- Plumbing Lic. no.: 4,- • 7 pa Plan review (25%ofpermit fee)
Authorized signature: n ,id State surcharge (12% of permit fee) 7Q
'I �^ Li TOTAL PERMIT FEE 1 2.() Print name: /60 /4 p Date: 9- , 7.- /t) Thu petmr a icon expires if p permit is not obtained within 180 days
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tca1/4 �""• '"'"W �( v �eS merSod�los1.1s7:{ yy'I'ri- County Building In Service BoarJ.
I:�auiiditptU'umm�App. \ 140 4616T( 0!02/COWR'Eti)
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