Permit CITY OF TIGARD PLUMBING PERMIT .
' - COMMUNITY DEVELOPMENT Permit #: PLM2009 -00060
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/23/2009
Parcel: 2S112CAl2200
Jurisdiction: Tigard
Site address: (-15555:SVV = 76TH AVE
Subdivision: RENAISSANCE WOODS NO. 2 Lot: 46
Project: Hubbard
Project Description: Replace approximately 55' of water service.
Owner: FEES
HUBBARD, STEPHEN A & Quantity Description Date Amount
DEBORAH J, 15555 SW 76TH AVE 55 If Water Service 03/23/2009 $55.00
TIGARD, OR 97224 1 12% State Surcharge - 03/23/2009 $8.70
PHONE:
Plumbing
18 ea Minimum Fee Adjustment 03/23/2009 $17.50
Contractor: - Plumbing
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503 - 239 -8801
FAX: 503- 669 -9568
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
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
Issue By: � r Permittee Signature:
v �
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.
Mar. 19. 2009 10: 44AM No. 9279 P. 1
1 , Plumbing omit ApplicaRECEIVED
Building Fixtures MAR 1 9 2009 `•• FOR OFFICE•UE ONLY
City of Tigflrtd
Received k--1 h n
batclI3 � ,in Pe rmrl Nn.: �L�(g�Q��Q kp
`+ 13125 SW Ha11131vd., Tigard, !• " +� TIGARD Plan Review
Er
Phone: 503.639.4171 Fa, : t ' 0. y Other Permit No.:
Inspection Line. 503.639.41 DIVISION Date/B
`RIGA &17 p Date Ready /9y: s: 0 See Page 2 for
. • Internet: www,tigard or.goV Notified/hMelhod: �C E Supplementallnformation
0 TYPE' o «'OiUC
FI '
New construction ❑ Demolition For special information tae checklist.
Description 1 Q. L Ea_ f Total
Addition/alteration/replacement ❑ Other: New a- 2- family dwellings (includes 100 ft. for each utility connection)
.
CATE . . ,
GOTt'Y'.:O COhS`1�IJCTION .:-... : :'. . . .
SFR (1) both 249,20
J- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
If Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq, ft_) Page 2
' .. ' • - JOB SITE uNFORMATTON'AND :LOCATION •
Slte utilities
Job site address: S u .7(..oth .. �� Catch basin or area drain 16.60
City/State/DR ( j 0 i e . ci 1?`, Drywell, leach line, or trench drain 1,6.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.. J ) Pagc 2
Manufactured home utilities 110.00
Cross street/directions to job Sile; Manholes 16.60
Rain dram connector 16.60
Sanitary sewer (no, linear ft.: ) Page 2
r Storm sewer (no. Iinear ft.: ) Page 2
Subdivision: Lot no,: Water service (no. linear ft.: dJ `, ) ( Page 2
Fix or item
Tax map /parcel no.:
,... Absorption valve 16.60
. DESC1tTPTION .OF „WOR
Backflow prcvcntcr Page 2
T y , 1 �i ���/// l c)1 Backwater valve 16.60
t( v Clothes washer 16.60
l c5
Dishwashcr 16.60
..
PROPERTY OWNER , D TENANT ': - nn fountain Drinking king POu � 16 60
Ejectors /sump 16,60
Name: #J 12, lint t A , Expansion tank 16.60
Address: Fixture /sewer cap 16,60
City /State /ZIP: Floor drain/floor sink/hub 16.60
phone: (G ne:i • -1D Fax: ( ) Garbage disposal 16.60
sc t
❑ IIo bb 1660
-
APPLICANT . ❑ CONTACT;PERSON
Ice maker 16.60
Business name: Interceptor /grease trap 16.60 ^
Contact name: Medical gas (value: $ ) �~ Page 2
Address: Primer �� 16.60
City/State/ZIP: Roof drain (commercial) 1,6.60
Sink/basin/lavatory 16,60
Phone:( ) — 1 Fax::( )
Tub /shower /shower pan 16,60
E -mail: Urinal 16.60
. ..CONTRACTOR Water closet 16.60 •
+
Business name:' f j/•, (Dry . 1. '2 i Q Water heater — 16,60
Address: `11// Other:
/� p � , Subtotal
City /State /Z1P: 0,, iiii !- `” l7� +4J Minimum permit fee: S72.50 �
Phone: tfy _ ,, r[j) Fax: ( pR' Residential backflow minimum permit fee: $36,25 7A
CCB Lic.: io -4/k Plumbing Lic. no.: / 53 Pia Plan review (25% of permit fcc) ,—
State surcharge (12% of permit fcc) O , 7E)
Authorized signature: 1,_-4-(--, TOTA
C., U $ r
/ _ L PERMIT FEE
Print name: , 6 '/ A , Date: it / Thls permit application expires if a permit it not obtained within
1$0 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
t; 19011ding \Permiis\PLMF- PermilApp.doe 12/27/06 440- 4 t16T00 /02/COMnVEB)