Permit CITY OF TIGARD PLUMBING PERMIT
o COMMUNITY DEVELOPMENT Permit #: PLM2010 -00317
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/05/2010
Parcel: 1 S 134CA00704
Jurisdiction: Tigard
Site address: 11905 SW SUMMER CREST DR
Subdivision: Lot: 0
Project:
Project Description: Sewer line repair, approximately 10'.
Owner: FEES
MADDOX, CURTIS & ALLISON Quantity Description Date Amount
11905 SW SUMMER CREST DR
TIGARD, OR 97223 10 If Sewer Service 10/05/2010 $62.54
PHONE: 1 12% State Surcharge - 10/05/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 10/05/2010 $9.96
Contractor: Plumbing
PIPE REPAIR SERVICES
PO BOX 5603
PORTLAND, OR 97228 -5603
PHONE: 503 - 701 -9625
FAX: 503 - 772 -9220
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
applica w.• All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
is nce, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
tility Notification Center. - r - . 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 OU • cal i 'g 503.246.6699 or 1.800.332.2344.
Issued By: 4 , / P ermifte Signature: t /42-4-
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.
Oct 01 10 04:41a Margo Miller 503- 266 -3810 p.1
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received
1,,
a 13125 SW Hall Blvd., Tigard, OR 97223 C { 1 7010 ryiO Pl y` " / /D
3i
7
Phone: 503.639.4171 Fax: 503.598.1960 Plan n R Review Permit No.: /�l
DateBy; Other Permit No..
Inspection Line: 503.639.4175 C ITY OF TIGARD Ready :By: : lur. •• -
TIGARD Date 0 See Page 2 for
Internet: www.tigard -or.gov i31 1 DINC DIVISION NotitiediMethod: f a Supplemental Information
TYPE OF W FEE' SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description j Qty. j Ea. j Total
X
Addition/alleration/repiacement El Oder•: New 1- 2-family dwellings (includes 100 fl. for each utility connection)
CATEGORY OF CONSTRUCTION
•
SFR (1) bath 312.70
J ❑ . 1- aad 2- family dwelling El Commercial /industrial SFR (2) bath 437.78
❑ Accessory building El Multi-family SFR (3) bath 900.32
❑ 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: � 7 C 5 j Gt...., - 5 • y .; /- t.1 /... /: G" •�:•� / Catch basin or area drain 18.76
1
Drywell, leach line, or trench dram 1 8.76
City /State/ZIP: / /r - 4 /-?-- /.2 CI /2-.
� � , Footing drain (no. linear fl.: ) Page 2
SSuite/bldg./apt. tto.: Project name: ,` Manufactured home utilities 50.03 ,
�
Cross street /directions to job site: ' D ox Manholes 1 18.76 I 1
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft: A') Page 2
Water service (no. linear ft.: __) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK • Backwater calve 1251
Clothes washer 25 02
c/ cv' / 1 ; / /1�/1. / � / i/ Z Dishwasher 2502
Drinking fountain 25.02
Ejectors/sump 25
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25,02
Address: Floor drainifloor sink/hub 25
Garbage disposal 25.02
City / State/ZIP:
Hose bib 25.02
Phone: ( ) Fax: ( .L -. Ice maker 12.51
❑ APPLICANT ,. ❑ CONTACT PERSON Interceptor /grease trap 25.02
M edic& gas al
Business name: v
(. ue: S ) Page 2
Contact Warne: w Primer 12.51
Roof drain (commercial) 12.51
Address: Sink basin /lavatory 25.02
City/State/ZIP: Solar units (potable water) 62.94
Phone: (: .:. 7 i:, /.^ .,.,/ Sl Fax:: (4 1,. j ) 77 J 2 - Tublshowertshow•erpan 12.51
E -mail: /j C 4 E :.= r// c /A- / /'Y/t IL.: • C ,:-/-,
Urinal 25.02
CONTRACTOR Water closet 25 ^2
• Business name: / /'/ /1 r� / � ,-- Water heater 37
/t- , /� /� J J r L i f _�» Water c n� DWV
ress: �` /.. /- -3 p � 56.29
Add
Y //� `X L c Other: 25.02
City /State2JP: /2L' /,: T/• /-f a 0 c ,;: 4 -__`' j /22 C.- Subtotal
Phone: (l ) 7 / _ j •6.. 5 _ . Fax: ( ) 7 2 _ j .2.2 t -. . Minimum permit fee: S72.50 ��- SU
CC13 Lic.: I Plan review (25°o of permit fee) -�^
(F "� 3r9 /lp, I Plumbing Lic. no.:
State surcharge (12 %ofpennitfee) it-
Authorized signature: . , . . ...• TOTAL PERMIT FEE ; gy. at,
Print name: , 'l ' A� (. Date a This permit application expires if a permit is not obtained nittnn 18U days
1 7 • i G " % I S /1 � �� after it has been accepted as complete.
`Fee methodology set by Tn- County Building Industry Set vice Board.
i.: S JillirrsTermite Tt- MU- PermitAppdoc I OIi09 440- 7616T( 1 0..0. /COM.'wEB)