Permit Er i i CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00235
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2009
Parcel: 1 S 136CA04000
Jurisdiction: Tigard
Site address: 11170 SW 79TH AVE
Subdivision: FRIENDLY ACRES Lot: 8
Project: Gearhart
Project Description: Replace 40' water service.
Owner: FEES
PALCIC, LILLIAN S Quantity Description Date Amount
11975 SW KING JAMES PL
KING CITY, OR 97224 40 If Water Service 08/26/2009 $55.00
PHONE: 1 12% State Surcharge - 08/26/2009 $8.70
Plumbing
18 ea Minimum Fee Adjustment - 08/26/2009 $17.50
Plumbing
Contractor:
POWER PLUMBING CO
PO BOX 19418
PORTLAND, OR 97280
PHONE: 503 - 244 -1900
FAX: 503- 244 -8825
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
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: /
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.
., AUG /26/2009 /WED 10:24 AM POWER PLUMBING FAX No, 503 244 8825 P. 001
Pius ibing Peri naait App U.cat CEIVED
rt Building Fixtures FOR OFFICE USE ONLY
AUG 2 6 2009 Received City Ti and Perzait
131 SW Hall Blvd., Tigard, OR 97,x:3 T p 1�a y u � L/� io9 �dQ 3
AM IGARD Plan Rev; •
g Phone: 503.639.4171 Fax: 503. $ 9 $ ,a7vv - DAte/g Ot}�er1'ezniltNo.:
-ri c.ARD Inspection Line: 503.639.4175 BUILDING DIVISION »* 1te,dy/By Fin ®see rase 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
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New construction ❑ Demolition Fors. ecial i ormatian use checklist
- - Descri •tion HIKVIN Ea. Total
P....• ditionlaltcration/replacemcnt ❑ Other New 1- 2- fantijy dwellings (includes 100 ft. for each utility connection)
x v , , �. '� a. ti o �• t }� c �� , 'a !T tt p f xti. ,:; SFR 1 bath 249 20
C ¢
F r ' : and 2- family dwelling 0 Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFIz (3) bath 399,00
Each additional batbIldiebea 45.00
Q Master builder 0 Other: ,
a , 7,`"'" Fire sprinkler L_ sq. ft) Page 2
" . ; -1: • , 4 ; i i' 6 ' _ 9 '' 0, �.' 1n' l S l t e ut iliti es
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Job site address: a 9 fD •- i i t - . / Catch basin or area drain 16.60 .
City /State/ZTP: 1 rI/ 1 DL . 7 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: V 'rojcct name: „__ ±��. ''- , .--',:f., ." ' Footing drain ( no. linear ft: )
Manufactured home utilities 110.00
Cross stzeer/dvectious to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no, linear i?..: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: 4'O Page 2
Fixture or item
Tax map /parcel no.: Absorption
a ti valve 16.60
, • �^ "'�. ' . T�' u�' . p' C'q�Gf 6 " " 0 "dv *' Y Bacldfow prCVentEY � �
IMM Irill "r _/� � Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
u na i r s c Nix ,' i ', "Wk,3 S> 1' / " 9 Dig fountain 16.60
Ejectors /sump 16.60
Name: 1,-/ LL/ "/ 4 LC /G Expansion tank 16.60
Address: ' - ,J ) air ,T ' L Fixture/sewer cap MI 16.60
City /State /ZIP: "f0 Gr Q' 7.22 Floor drain/floor sink/hub 16 -60
Phone:.(5' ) O - 5 „2 Fax: ( ) f rltbage disposal 16.60
• � m , �y �F ., °r~ . � , ,s , v r�t: Hose bib 16.60
• ;e ? 2 = tj , L.t Ft: n. " 1 . l 't.=k . at .ti'.. . t",+ ,. '�lk. ' I
M. ddi�h "P� ak `�i�;�- .r,-,- �l". F
�, Ice makea I6.60
Business name: ii I [ y '1 Of J/L . r / • ,Tutezceptnr /grease trap 16.60
Contact name: WI( / j___,/ V /'//. Medical gas (value: 3 ) Page 2
• Address: / ■ I 6 ILA ` . to /J Primer ■ 16.60
City /State/ZII': Pe igi .. _L d D7_ ' Roof drain (commercial) 16.60 MI
�t l Pax.' ��. Sinic/basinnavatory 16.60
Phone: ($Z) ,141.1- i q a) : (563 c;• e lii ^
, Tub /shower /shower pan 16.60
E Urinal NM 16.60
• . emu'" M,, k, � . 6f .F k�' f�l G� v u :v -" . � I,�! .t � } ' i k ^ off.. t r 1 r i ' 1
+ r te, �,s�:ihp. Wi`�xl: "` ��F ?�wa��atc`ftl� +� + ' ; � Waterclosel 111M 16.60
Business name: / - / Ar yt 40 . Water heater 16.60 IIIII
Addr 6 I A. ' Other MI
• city/State/ZIP: Subtotal m
,to g # L Minimum permit fee: $72.50
Phone; ( 2 ) a NU 90 Fax: 2 ,) a 1 L ' l t ' - c 7 - m i n i m u m $36.25 7 ,
I cal Lit.: Pl um bi ng . Lic.n o.: • , ' Plan review (25/oofpezmitfee) ._-_.�
e . i State Autho surah (122b,0 of permit fee) EMI
rized signature:
Authorized • ow ... .. . _ ..... .... .............._ :...,,.... . .., �.
Print name: ' Q Date: 0 This permit application expires if a per.tnit is mot obtained within
/ / 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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