Permit CITY OF TIGARD PLUMBING PERMIT
IN COMMUNITY DEVELOPMENT Permit #: PLM2010 -00368
T 1 GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2010
Parcel: 2S110DD02600
Jurisdiction: Tigard
Site address: 10595 SW CENTURY OAK DR
Project: Subdivision: SUMMERFIELD NO. 1 Lot: 33
Project Description: Plumbing to remodel kitchen and bathroom.
Contractor: EAGLE PLUMBING ENTERPRISES INC Owner: GIESBRECHT, H DEANNE
13801 S FORSYTHE RD 10595 SW CENTURY OAK DR
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: 503 - 650 -8703 PHONE:
FAX: 503 - 650 -8720
FEES
Quantity Description Date Amount
1 ea Dishwasher 11/10/2010 $25.02
Specifics: 1 ea Sink 11/10/2010 $25.02
1 ea Lavatories 11/10/2010 $25.02
Type of Use: SF 1 ea Water Heater 11/10/2010 $37.52
Class of Work: ALT 1 12% State Surcharge - 11/10/2010 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
•
Total $126.09
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifi ion - -Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct uestions to O C b -ilin. 03.232.1987 or 1.800.332.2344.
Issued By: , - CLI-.4Z■ Permittee S nature: / ���f ( � ' r",
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Nov 09 10 10:36a Microsoft 503- 650 -8720 p.1
Plumbing Permit Applicatit CEIVED
•
Site Utilities NOV 9 2010 FOR OFFICE USE ONLY
. Ci ty g of Tigard Received
I Permit No.: �/ ! /t „ 3 6g
II
0 13125 SW Hall Blvd., Tigard, OR OF TIGARD DateBy: �� 9 ! ,,/ e-/T 0 70 ��CJ (l
Phone: 503.639.4171 Fax: 50 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 ING DI VISION Date/By:
I I G ,� R I� Date Ready /By: luris: I ®$« Page 2 for
Internet: www.tigard-or.gov Notified'Method• Supplemental Information
TYPE OF WORK FEE* SCHEDULE
F or special information use checklist
El New construction ❑Demolition sP l
Description II Qty. I Ea. I Total_
( Addition/alteration/replacement ❑ Other: New I- 2- family. dwellings (includes 100 11. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
R and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
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: /oS9 S ,5 co c 5 _2 _t, _ Catch basin or area drain 18.76
CitylState/ZIP: Drywell, leach line, or trench drain 18.76
/ 1 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: a, ,,biefc..tl'Ti- 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 It.: ) Page 2
Subdivision: Lot no.: Fixture or item: _
Tax map /parcel no.: Bacl: flow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Q Clothes washer 25.02
P N ,wt.`► - � / ,ti- �• if ' .. - Dishwasher I 25.02 0 /5.4 , 9"
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02 i
City/ State/ZIP: 1•lose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: 5 ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 1,... 25.02 50, . ci f
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) ' Fax: : ( ) 'rub/shower/shower pan 12.51
E -mail: Urinal 25.02
- Water closet 25.02
CONTRACTOR
Water heater , 37.52 37. 6-2
Business name: , / I . _
K- i� r 4 Water piping/DWV 56.29
1 Address: /3fo / e y . , 1 2J Other: 25.02
City!StateJZIP: / r . fe) e i''7 p q s �� . Subtotal _
.`fix
I Minimum permit fee: $72.50 �-
Phone: ( 61.0 j) c, 1 - a 7e 3 Fax (SC)) G co-e? 2.0 Minimum
review (25% of permit fee)
CCB Lic.: 4-, 11 14 4�A5/'I/ Plumbing Lic. no.: 3- /514 f5 5 ' State surcharge (12 %ofpermit fee) /3.5/
Authorized signature: TOTAL PERMIT FEE /A6, ray
I Print name: ,L Date: � c' This permit application expires if a permit is not obtained within 180 days
�a /� I! d-�-s f �I after it has been accepted as compkte.
*Fee methodology set by Tri- County Building Industry Service Board.