Permit •
H CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00061
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/23/2009
Parcel: 2S112CB11700
Jurisdiction: Tigard
Site address: 15370 SW 81ST AVE
Subdivision: ASHFORD OAKS NO. 2 Lot: 131
Project: Bekkedahl
Project Description: Install water lines for tankless water heater.
Owner: FEES
BEKKEDAHL, ERIK Quantity Description Date Amount
15370 SW 81ST AVE 1 If Water Service 03/23/2009 $55.00
TIGARD, OR 97224 1 ea Water Heater 03/23/2009 $16.60
PHONE: 1 12% State Surcharge - 03/23/2009 $8.70
Plumbing
Contractor: 1 ea Minimum Fee Adjustment 03/23/2009 $0.90
GEO A MORLAN PLUMBING & APPL CO - Plumbing
2222 NW RALEIGH ST
PORTLAND, OR 97210
PHONE: 503 - 274 -1444
FAX: (503)624 -8251
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
r �
Issued By: \ 1/, {� �. ,^ A () p (� Permittee Signature: I WA1.10 0Y)
( � \J � LJ r `A 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.
..'la 09 09:51a 5036248251 p.3
Plumbing Permit Applicati4WCE NED
Site Utilities I IL. FOR O rcl: IsI oar
City of Tigard MAR 2 0 2009 Deceive Plan Review
Q d Permit No.: i . peel 9 GID46/
• 13I25 SW Hall Blvd., Tigard, OR 97223 y
IA Plan Review
.
Phone: 503.639.4171 Fax: 503.59. Date/By: Other Permit No.:
Inspection Line: 503.639.4175 OF TIGARD Date Ready /By: runs: 1 El See Page 2 for
TIGARD Internet: www.tigard-ar.gov BUILDING DIVISIO Notified/Method: dr4, Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description j Qty. I Ea. j Total
( ' gAdditionlalteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
[j l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: J
Fire sprinkler ( sq. It.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 153-7 (3 S VU p l 5t Catch basin or area drain 16.60
City /State/ZIP: s. 4 _12Z Drywell, leach line, or trench drain 16.60
Suite/bldgJapt. no.: Project name: -1 Footing drain (no. linear ft.: ) Page 2
- �� D ��� Manufactured home utilities 110.00 I
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear R.: ) &NO Page 2 55.00
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
51nn .{r 11 ✓jl? �7 1� Backwater valve 16.60
* 1i1� J(j ,te t i . 1n� Clothes washer 16.60
6, 1 `A�CL Y (f[ QC Dishwasher 16.60
PROPERTY OWNER ( ❑ TENANT Drinking fountain 16.60
Ei- Ejectors /sump 16.60
Name: E i t, l,. -4, E V 0.- I Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State/" /_1P: Floor drain /floor sink/hub 16.60
( )
Phone: ( ) Fax: Garbage disposal 16.60
APPLICANT ❑ CONTACT PERSON Hose bib 16.60
4 ,r, Ice maker 16.60
Business name: ( ty /j�0 J p )r l IA ' l JV) f)\ V _i Interceptor /grease trap 16.60
Contact name: ` �.U9r - Medical gas (value: $ ,) Page 2
Address: 'aa�.:9., U V\&) t- \c k st Primer 16.60
y 61 . , o Roof drain (commercial) 16.60
City/State/ZIP: �� r � 1 Q Z
( Z7 - I . , 3) 62 2/4 _'8 25 Tub/shower/shower 16.60
Phone: Fax:
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: C-V (5vV � MADVAC Water heater 1 16.60 //
Address: � " N�,3 ri<Q t ck tit ;,-.t- Other:
City /State /ZIP: O r * C t,1 ft � -1 2 � �
t Minimum permit fee: Subtot $72.50 al 7 1 . �0
�/�
Phone: (5S 2. .7q_ 1 (�. L Fax_ 2, .-g 2J 1 Residential back minimum permit fee: $36.25 1 1 2 -. 0
CCB Lie.: 2-7 • . Plun bing Lic. no.: a - LeL7Pe7 Plan review (25% of permit fee)
1 $
State surcharge (12% of permit fee) ..7Q
Authorized sign'u �v .� / � ��� TOTAL PERMIT FEE g 2 0
Print name: _ Q - A ' ip e it Date:.3. f I q 1 01 This permit application expires if a permit is not obtained within
/` 180 days after it has been accepted as complete.
•f Pe methndolonv set by Tri County Rnildino Industry Service. Rnard