Permit - ,, CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00390
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010
Parcel: 1S133DB01200
Jurisdiction: Tigard
Site address: 11640 SW SHEFFIELD CIR
Project: Felton Subdivision: Lot: 0
Project Description: Install new clothes washer and laundry tray.
Contractor: POINT PLUMBING Owner: FELTON, JASON
4200 SW 175TH AVE 11640 SW SHEFFIELD CIR
ALOHA, OR 97007 TIGARD, OR 97223
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PHONE: 503 - 708 -5670
PHONE: 503 - 265 -1708
FAX: 503 - 268 -1567
FEES
Quantity Description Date Amount
1 ea Clothes Washer 12/21/2010 $25.02
Specifics: 1 ea Laundry Tray 12/21/2010 $25.02
1 12% State Surcharge - 12/21/2010 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment - 12/21/2010 $22.46
Plumbing
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 -0090. You may obtain a copy of the rules
or direct q •. • •UNC • . ailing 503.232.1987 or 1.800.332.2344.
Issued ;y: P / 0 Permittee Signature: �� /
-0 -
— -- ,
CaII 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.
Dec 21 10 08:28a Josh 503 -268 -1567 p.l
Plumbing Permit Application
Building Fixtures RECEIVED l' a ,..1.1(.. t'5 1' ONLY
City of Tigard / Received
■ 13125 SW Hall Blvd., Tigard, OR 97223 L C 2 2 Q O DateB _� Permit No.: • , O / j D (I
1 Da
Phone: 503.639.4171 Fax: 503.598.1960 D n Review Other Permit No.:
Inspection Line: 3 41
ction 50.639.75 ate By:
- I l t; n RD
Internet: Line: g 03 . CITY OF TIGARD Date Ready/By: ions. See Page 2 for
UII,DING DIVISIO Notified/Method: Supplemental Information
TYPE OF WO FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Vr Description 1 Qty. f Ea. f Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
Fri- 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: 1/6 t it' 5, . ,i,t gliA,�A C 4 v_�, Catch basin or area drain 18.76 R.
City/State/ZIP: j i `� "r Drywell, leach line, or trench drain 18.76
k '
0 Footing drain (no. linear ft.: ) Page 2
Suite/bldgiapt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: t'
J / _c��w Manholes ...
16.76
Rain drain connector 18.76 ^
Sanitary sewer (no. linear ft.: ____) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31,27
DESCRIPTION OF WORK Backwater valves 12.51
nc� is 1 , - -).07 ).0 1 L\ -Pawl - Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: - T, v . 1 � Fixture /sewer cap 25 -02 r
Address: it L.Lic S. w, S hy N \ a Floor drain /floor sink/hub 25.02
IN e. �l . Garbage disposal 25.02
City /State /LIP: `1- ,c/ H bib
� 25.02
Phone: (9:v3 ) 7v - 56 7‹., Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 -
Business name: R., ,, n -- p 1, � ` Medical gas (value: $ ) Page 2
-
Contact name: Primer 12.51
.� of �- 'V- vKw� C S C..-•
�L Roof drain (commercial) 12.51
Address:
!` S: i✓. j7S Sink/basin/lavatory 25.02 .02_ City /State /ZIP: A Tl , e 7� 7 Solar units (potable water) 62.54
Phone: ( ) .2k 1745 ,... F :: (57) �15 i -z 7 Tub /shower /shower pan 12.51
♦ / Urinal
oc, • r`k' cl�ww��i\ , ,,r vievti •w. c.v :- -7 25.02
E -mail: -
CONTAACTOR Water closet 25.02
Water heater 37.52
Business name: 'Qv1 -`-s v,.,,,,..,,;.- Water t m WV
Address: ) p p gfD 56.29
kl)i
•.1� :5� (� +•..- r7S-e-� Other: 2
5.02
City/State./ZIP: y7�p,� Sutotal v�
Phone: (602 ) 2d yam),7a
Fax: ( r, ) Minimum permit fee: $7
CCB Lic.: jiv/ Z 4/'/, Plumbing Lic. no.:pg '8.-s-4, Plan review (25% of permit fee)
State surcharge (12% of permit fee) %? -/
Authorized signature: 7�l A `�� -� p -^ TOTAL PERMIT FEE 8-/
Print name: - 5� L- -t,.�..>zb,,sSc - ` Date: i2 - 2/ This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete
"Fee methodology set by Tri- County Building Industry Service Board.