Permit CITY OF TIGARD PLUMBING PERMIT
I
It COMMUNITY DEVELOPMENT Permit #: PLM2011 -00067
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/04/2011
Parcel: 2S111 CC00600
Jurisdiction: Tigard
Site address: 10085 SW CENTURY OAK DR
Project: DELUCA Subdivision: SUMMERFIELD NO. 1 Lot: 3
Project Description: Replacing water piping.
Contractor: DAVIS PLUMBING Owner: DELUCA, RAYNOLD E SR &
PO BOX 516 KATHERINE J
SANDY, OR 97055 10085 SW CENTURY OAK DR
PORTLAND, OR 97224
PHONE: 503 - 307 -1920 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Piping /DWV 03/04/2011 $56.29
Specifics: 1 12% State Surcharge - 03/04/2011 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment - 03/04/2011 $16.21
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 adopte y the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain copy of the rules
or direct questions to • NC by calling 503.232.1987 s : S = .2344.
Issued B ^+'ttee Signature: ' ��
s y
Call 50 . • 9.4175 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.
Plumbing Permit Application
Building Fixtures .. FOR OFFICE USE oNi.l
City of Tigard �� %\ EEew PermitNo.: 4A
11 13125 SW HaBlvd, Tigard, OR t - t: Phone: 503.718.2439 Fax 503.598.1 D B y Other Permit No.:
A ` _
TI G A R D Inspection Line: 503.639.4175 C A1 ' ■C O ` Date Ready/13y Jugs: H See Page 2 for
Internet: www.tigard or.gov ` O �91 Notified/Method: Supplemental Information
TYPE OF WORK X 1 FEE* SCHEDULE
El New construction ❑ l molition For ' in onnation use c
Description Qty. Ea. Total
"Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft for each utility connection)
GTE ORY OF CONSTRUCTION : SFR (1) bath 31230
12`1 and 2 - family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
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: /00 '75 f. () �J r ..J 0/9 k N r Catch basin or area drain 18.76
vv Drywell, leach line, or trench drain 18.76
City/State/ZIP:' ,,, /+ y l
J �! � 0 � 7z Z / Footing drain (no. linear R: ) Page 2 -
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
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
DE.N Backwater valve 12.51
Clothes washer 25.02
R .,'--/61457 //_ ll y � /
n i!/ '49 7- �1 o!/.t G Z.../'5/ / I Dishwasher 25 - 02
/1-7//°//‘-j Drinking fountain 25.02
Ejectors/sump 25.02
Q PROPERTY OWNER I ❑ Mara i1 Expansion tank 12.51
Name: / l A? .!),e_ ��� Fixture/sewer
drain/floor sink/hub cap 25.02
/� Floor I 25.02
Address: .5;‘9,...)„,_ ,057.....5.- // °' L./Z
Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ AFFIJCANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
Water heater
CONTRACTOR
/
Business name: L�i9v Pl Water piping/DWV 37.52 l
/ 1 56.29
� . ��e s �
Address: Other: 6 25.02
v
City /State/ZIP: 5 7 65'8 Subtotal
Phone: (os • 3 ) 3d 7- / Z Q Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: /13 S - 09/11 Plumbing Lic. no, S"$'� Plan review (25% of permit fee)
/ d �/ r / I I State surcharge (12% of permit fee) . 70 Q
Authorized signature: ��� ' TOTAL PERMIT FEE ,. Print name: �D c' . S /)�7v i Date: 3 - 4 / ,, v This permit applicat expires if a permit is not obtained within 180 days
r after it has been accepted as complete.
*Fee methodoloev set by Tri- County Building Tndu.stry Service Board