Permit CITY OF TIGARD PLUMBING PERMIT
s • COMMUNITY DEVELOPMENT Permit #: PLM2010 -00326
T 1 G A R. L) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/12/2010
Parcel: 2S102BD00100
Jurisdiction: Tigard
Site address: 9905 SW MCKENZIE ST
Subdivision: Lot: 0
Project: St. Anthony's Church
Project Description: Adding yard hydrant hose bib in new parking lot.
Owner: FEES
ROMAN CATHOLIC ARCHBISHOP OF Quantity Description Date Amount
PORTLAND IN OREGON, 2838 E BURNSIDE
PORTLAND, OR 97214 1 ea Hose Bib 10/12/2010 $25.02
PHONE: 1 12% State Surcharge - 10/12/2010 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 10/12/2010 $47.48
Contractor: Plumbing
ACTIVE PLUMBING LLC
330 W FAIRFIELD ST
GLADSTONE, OR 97027
PHONE: 503 - 927 -5169
FAX: 503 - 722 -5310
Type of Use: COM
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.
IMP
Issued Permittee Signature:
'� .141_
411 r110
Call 13.639.4175 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 08 10 03:09p Mike And Nicole Manley 5037225310 p.1
Plumbing Permit Application -kN'°)
Building Fixtures 06 :\‘ Fol; Orrick 1 SE ONI..l
City of Tigard c.,,_.-.\ P►�""
SS _ o>., v r I f o 137'7 it No.: 3[)w- J(13)'6
4 131 25 SW Hall Blvd., Tigard, OR 97223 �
a ' Phone: 503.639.4171 Fax: 503.598.1960 0 � 1 �gY Other Permit No.:
Inspection Line: 503.639.4175 l' N G �I Date Ready/By: tuns: 8 See Page 2 for
T I G:� h D Internet: www.tigard-or.gov
C 9 Notified/Method: "7176i I Supplemental Information
TYPE OF WORK - FEE* SCHEDULE
` ❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
A Addi tion/alteration/replacemurtt ❑ Other. New 1- 2- family dwellings (includes 10011. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
SFR (2) bath 437.78
❑ 1- and 2- family dveelling rm
Conercialfndustrial 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:
Catch basin or area drain 18.76
Job site address: qCl 0 C LK4v(1 21 't'. ~ • Drywell, leach line, or trench drain 18.76
City/State/ZIP: h irer ,,,....4i DI2-. ct Footing drain (no. linear ft.: ) Page 2
Suite/bldgJapt no.: Project name: "' AnTn i f I ii Ca) Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 1836
Rain drain connector 18.76
Sanitary sewer (no. linear ft: _„) Page 2
Storm sewer (no. linear ft.: 0 Pape 2
Water service (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Bacldlow preventer 31.27
Tax map /parcel no.:
Backwater valve 12.51
DESCRIPTION OF WORK
^ 1� Clothes x�ha 25.02
G . O'ra n t (, ire ID l`[ . l 11 Dishwasher 25.02
pa r -i n of l Ott f t N poi r -; nOI / lot) Drinking fountain 25.02
1 Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name: Floor drainifloor sink/hub 25.02
Address: Garbage disposal 25.02
City /State/ZIP: Hose bib I 25.02 2G . a2,
Pte ( ) Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 2
Medical gas (value: $ ) Page 2
Business name: ?Gt i V . P k � 1Y1 b 1 ri i) LL C-
Primer 12.51
Contact name: M i lie M c n i " y R drain (commercial) 12.51
Address: � j �j D W f U 1 r k e i ti 5t_. Sink/basin/lavatory 25.02 rr
City /StatelZIP: (I.1 n &c9t t f 2 6 11 0 21 Solar units (potable water) 62.54
Phone: (C ) Q 21 ' �j ( 4 Fax:: ( 1 0 Tub/shower/showerpan 12.51
�cr� ;� r � -- ^ Urinal 25.02
E -mail: l.tL� e�� i� m'p ��11G r W m Vtt�1 l Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: Water piping/DWY 5629
Address: A bO V P Other 25.02
City/State/22P: Subtotal 71ij _Ql
Minimum permit fee: $72.50 ) i s-2 2
( ) F ax ( ) p L3Io�t p Plan review (25% of permit fee) /r 7VV
CCB I ic.: 1 2 Plumbing Lic. no.: L
��+ 1 Stec st r (12% of permit fee) ,'
Authorized signaor>Te: �T c 11 Q tXR TO TAL PERMIT FEE •
l 1 l�`�' p �q y) j This permit application expires if a permit is not obtained who day
Print name: CRS i e tV l l t' 9 1 �. ate: lb ":6-‘ after it has been accepted as complete.
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