Permit r
q CITY OF TIGARD PLUMBING PERMIT
I
3 . " COMMUNITY DEVELOPMENT Permit #: PLM2010 00380
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2010
i G'A R IJ' g Parcel: 2S102CAD0926
Jurisdiction: Tigard
Site address: 13260 SW VILLAGE GLENN DR
Project: Freels Subdivision: VILLAGE GLENN Lot: 26
Project Description: Replacing (50) ft. of water service. Electrical permit may be required if replacement piping affects house
grounding.
Contractor: PORTLAND PLUMBING CO Owner: FREELS, MARK H & KATHLEEN M
16470 SW SWAN AVE 13260 SW VILLAGE GLENN DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 723 -8800 PHONE:
FAX: 503 - 723 -8801
FEES
Quantity Description Date Amount
50 If Water Service 11/24/2010 $62.54
Specifics: 1 12% State Surcharge - 11/24/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 11/24/2010 $9.96
Type of Use SF Plumbing
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 ■ .. -- 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 d ect questions t• •UNC calling 503.232.1987 or 1.800.332.2344.
Is ued By: / j e C tr(zRA , i , Permittee Signa Z
Call 503.639.4175 by 7:00 a.m. for the next available ins. - ion 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 23 10 09:41p Portland Plumbing 5037238801 p.2
Plumbing Permit Application
OP
Building Fixtures FOR OFFICE USE ONLY
City of Tigard , ' �� ^�`O Received
n ' 1 - Date /6 t Permit N. I y)3�
M
13 Phone: SW Hall Blvd., Tigard, OR 9 ?�" y ail r / id -
Phone: 503.639.417I Fax: 503.598. i 960 �. Ian Review
TIGr�RD Inspection Line: 503.639.4175 �� �*� 1.S` Date Re
Other Permit No.:
Internet www.tigard•or.gov Date Ready By: .u. t See Page 2 for
,C� �6) Notified/Method: / • Supplemental Information
" • . TYPE OF WORK C ` � \ >
' FEE* SCHEDULE EDULE • • • ❑ New construction ❑ Dem icon For special information use checklist
Description Total
Addition/alteration/replacement ❑ Other: Qty Ea.
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
❑ 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: 13260 SW Village Glenn Dr. Catch basin or area drain 18.76
City/State/ZIP: tigard ,OR 97223 Drywell, leach line, or trench drain 18.76 '
_ Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: Project name:
rv'CS -� Manufactured home utilities 50.03
Cross street/directions OA site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.:. ) Page 2
Storm sewer (no. linear It.: ) . Page 2
Water service (no. linear ft.: Page 2 62,54
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Baekflow preventer 31.27
. DESCR
Backwater valve 12.51
PTION OF WORK . .
new water service Clothes washer _ 25 02
-
_ Dishwasher 25.02
Drinking fountain 25.02
Ejectots!sump 25.02 i
❑ • PROPERTY .OWNER . 0 TENANT Expansion tank 1251
Nance: Mark and Kathy Fixture/sewer cap 25.02
Address: 13260 SW Village Glenn Dr_ Floor drain/floor sink / hub 25.02
Garbage disposal 25.02
City/State/ZIP: tigard or 97223
Hose bib 25.02
Phone: ( ) Fax: ( ) . Ice maker 12.51
• ►t •APPLICANT ❑ CONTACT PERSON • Interceptorigrease trap 25.02
Business name: portland plumbing Medical gas (value: $ ) Page 2
Contact name: dan white Primer 12,51
Roof drain (commercial) 12,51
Address: 16470 s swan ave
Sink/basin/lavatory 25.02
City /State /ZIP: Oregon city or 97045 Solar units (potable water) 62.54
Phone: (503) 723 -8800 Fax: : (503) 723 -8801 Tub/shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: portland plumbing
Water pipi g/DWV 5629
I Address: 16470 s swan ave
Other 25.02
City /State /ZIP: oregon city or97045 • Subtotal 62.54
Phone: (503) 723 -8800 Fax: (503) 723 -8801 Minimum permit fee: $72.50 72.5
CCB Lic.: 162139 4// Plumbing Lic. no.: 3 - 530pb Plan review (25% of permit fcc)
State surcharge (12% of permit fee) 8.70
Authorized signature: t ro-•., . 07- l TOTAL PERMIT FEE 81.2
Print name: daniel white hl / Date 23� 171'2010 This permit application expires ita permit is not obtained within lad days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:U3uilding \Penn its\PLMC- PcrmilApp duc 10/01/09 440- 46:6'T( I0 /021COtd/WE13)