Permit CITY OF TIGARD PLUMBING PERMIT
"'� COMMUNITY DEVELOPMENT Permit #: PLM2011 -00025
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/21/2011
Parcel: 2S104DD07000
Jurisdiction: Tigard
Site address: 12799 SW RIDGEFIELD LN
Project: ROWLAND Subdivision: MOUNTAIN HIGHLANDS NO. 3 Lot: 28
Project Description: Replacing 75 ft. of water service.
Contractor: CASEY'S PLUMBING Owner: ROWLAND, PAUL &
PO BOX 30075 IMELDA DACONES REVOC TRUST
PORTLAND, OR 97294 12799 SW RIDGEFIELD LN
TIGARD, OR 97223
PHONE: 503 - 253 -0030 PHONE:
FAX: 503 - 262 -8251
FEES
Quantity Description Date Amount
75 If Water Service 01/21/2011 $62.54
Specifics: 1 12% State Surcharge - 01/21/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 01/21/2011 $9.96
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 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 questions to OUNC by calling 503.232.1987 or 10.33_ • 4.
Issued By: . Permittee Signature: 411111%.M.. _ .fdji11iimrr
Call 50 . •.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.
Jan 20 11 08:33p Case 's Plumbing 5032628251 p.1
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received Date/By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 9R " 2 ° ' � '�' V • �'
Plan Review
77 P hone: 503.639.4171 Fax: 503.598.19¢� •
0 2011 Date/By:
Permit No.:
TI G ARD Inspection Line: 503.639.4175 JAN Date Ready /By: runs: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: .. Supplemental Information
TYPE OF WOR2ITY OF I IUPi 1U FEE* SCHEDULE
❑ New construction L-!I°Bemoliti' \i 1:71tJ1 a{ For special information use checklist
Description I Qty. I Ea. I gjltddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
f and 2-family dwelling SFR (2) bath 437.78
y g ❑ Commercial/industrial
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: _
Job site address: G (� Catch basin or area drain 18.76
f i S 1- C��L� • 4 ' e �C1 Drywell, leach line, or trench drain 18.76
City/State/ZIP: � �� Q 3
! - Footing drain (no. linear ft.: ) P 18. 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
(a - - 4o.-C ` / /,_ t-e_, i Rain drain connector 18.76 ii �' Sanitary sewer (no. linear ft.: ) Page 2
0, a s ma �� Jr �� Storm sewer (no. linear ft.: _ ) Page 2
Water service (no. linear ft.: i7 5) / Page 2 (
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION ION OF WORK
valve 12.51
Clothes washer 25.02
`L'� , AA(4 ,tiM. �..) f -4 Dishwasher 25.02
1 Drinking fountain 25.02
Ejectors /sump 25.02
' ROPERTY OWNER ❑ TENANT Expansion tank 12.51
�� r) Fixture /sewer cap 25.02
Name: 2,v rjr
Address: ' a r 1 CI e: a ) , ) Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /State/ZIP: 1,... 1) D n
3 Hose bib 25.02
Phone: ( 503) 5-7 _ - Fax: ( ) Ice maker
12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
$usiness name: /'
ja. .. LL..1 k. ,\j l``1,
Primer 12.51
Contact name: . C ck . -
Roof drain (commercial) 12.51
Address: t� . I, �7 .
�J Sink/basin / lavatory 25.02
City /State /ZIP: � 3 c _ d t (3Q �-- 1 t 1
R. `1 Solar units (potable water ) 62.54
Phone: ( \.) a r, A ex j Fax: : (a) a .Dna l Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
C C>' \G.C`- � chO.t� \�, < < �� N Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: C f.( 'f /3 -` A nr ,. \ 1 6th Water piping/DWV 56.29
Address: (•) . ` � Other:
` ' 25.02
City /State/ZIP: (- - \(In ! t ( C1-12-9L1 Subtotal
Phone: (,Q) a6�?r- t ' �
_ Fax: („ ) Q Via_ < t Minimum permit fee: $72.50 '7 a 50
CCBLie.: )L\- z Plumbing Lic. no.: aL ,= 1? - ?a Plan review (25 % of permit fee)
State surcharge (12% of permit fee) , O
Authorized signature:( TOTAL PERMIT FEE
Print name: N 64( ! e L lA.{' a+ k l Date: r 20 _I ( 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.
1: 1Buitding \Permits\PLMU- PennitApp doc 10701/09 440- 16l6T(1o102/CO\t/lvEa)