Permit CITY OF TIGARD PLUMBING PERMIT
' a COMMUNITY DEVELOPMENT Permit #: PLM201000342
T 1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2010
Parcel: 2S102DA00800
Jurisdiction: Tigard
Site address: 13335 SW HALL BLVD
Subdivision: Lot: 0
Project: City of Tigard - Fanno Creek House
Project Description: Interior plumbing: (3) sinks and (2) water closets.
Owner: FEES
TIGARD, CITY OF Quantity Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 3 ea Sink 10/21/2010 $75.06
2 ea Water Closet 10/21/2010 $50.04
PHONE: 503 - 639 -4171 1 12% State Surcharge - 10/21/2010 $15.01
Plumbing
Contractor:
WESTERN PLUMBING
9460 SW TIGARD, AVE STE 101
TIGARD, OR 97223
PHONE: 503 - 639 -5296
FAX: 503 -684 -9015
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $140.11
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 OU by calling 503.246.6699 or 1.800.332.2344. <:001141110
Issued By: / Permittee Signature: • . ` /
Call 5.3.639.4175 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.
10/20/2010 16:13 5036849015 WESTERN PLUMBING INC PAGE 01/03
P1umbina Permit Application „ �
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Permit .: _
13125 SW hall Blvd, Tigard, OR 97223 , K�' , = • 10 U
Phone: 503.639.4171 Fax: 503.598.196 \
0 ' C) 1 O Plan ter Review Otbsr PsmTit No.:
Ci rt R D Inspection Line: 503.639.4175 Q�C 9 �1� $ 1 ,�, ANN '� -3S
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1V 1- and 2- family dwelling 1] Commeactal/industrial 8F8 (2) bath 437.78
C3 Accessory building 0 Multi-famiity SPk (3) bath 50032
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Job site address: I )03_.-.2.._ C. �� \„` n (� V-A `r 1 , c basin or wee drain 18 76
City /Stare /ZIP 1 \ ,, ` �V . 4-- `, uv ? \ -� Y�11, leach !my a trench dram 1 R76
Footing drain (no. barter 8 : _) Page 2
Snite/hidgJapt. no.: Project frame: home unities 50.03
Cross street/directions to job site: Manholes 18.76
Ram drain camacter 18.76
• Sanitary sewer (um linear tti: _ _) . Page 2
Storm sever (no- linear 8.: ____) Page 2
Wake service (nog Bitters:_) Page 2
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Fixture or item
Tax tnap/pareel no.: Backfow ptevatuer J 31.27
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Name: V Fame/sewer cap 25.02
• --- Pbaar dam/floor aiekibub 25,02
- City /Stete/ZIP: Crsrb�e d 25.02
Hose La. 25.02
Phone ( ) Fax ( ) I maker
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Co[lfficr envie: I Primer 125
.Address: Roof dude (commercial) 12 5 1
Si�lb�mllavatat Y % j 25 ' � (�
City/State/ZIP:
Solar units (potable water) 62.54
Phone: ( ) Fs2c : ( ) 'nib/Mower/shower pan 12.51
E �+aat 25.02
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Business name: Western P1mnbing, Inc.
Water Pi wv 56.29
.Address: 9460 SW Tigard Aventro Suite 101 Othar. 2502
City /State/ZIP : Tigard, OR 97223 ___ Subtotal 1 , S 6
Phone: (503) 639 -5296 Fax (503)684-9015 Ivrtmm �m Permit fee: $72.50 ��
•
CCB Lic.: 2439 Plumbing Lis_ no.: 3429PB Pfau review (25% ofpenooit fee)
State serge (1.2%of Permit tcc y '
Authorized signature: 04#0, . ` '
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• .` TOTAL PHItIy(IpPES
Print name: Dana Jensen 9 Date: D - i - This woo applleatlon ewes u ■ permit hoot obtatme *i u 80
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