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Permit t CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 -00136 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/29/2011 Parcel: 2S112BB14200 Jurisdiction: Tigard Site address: 14371 SW FANNO CREEK CT Project: ELLEDGE Subdivision: COLONY CREEK ESTATES NO.5 Lot: 121 Project Description: 50 ft. of water service. Electrical permit may be required if house grounding is affected. Contractor: 3 MOUNTAINS PLUMBING Owner: ELLEDGE, ANNE E PO BOX 230051 14371 SW FANNO CREEK CT PORTLAND, OR 97281 TIGARD, OR 97224 PHONE: 503 - 670 -1342 PHONE: FAX: 503 - 828 -0515 FEES Quantity Description Date Amount 50 If Water Service 04/29/2011 $62.54 Specifics: 1 12% State Surcharge - 04/29/2011 $8.70 Plumbing Type of Use SF 10 ea Minimum Fee Adjustment - 04/29/2011 $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 1.800.332.2344. Issued By: •ermittee Signature: Call 503.6 9. • 75 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. , APR -28- 2011.11:29 From: To :5035981980 Pa9e:2'2 Plumbing Permit A tica tio CEIVED Building Fixtures FOR OFFICE USE ONI.V City of Tigard Received I : APR 2 8 2011 Date/13y: �j y: , t h7/ Permit No.: �L,, d 13125 SW Hall Blvd„ Tigard, OR 97223 APR l�Cr1 �l1 -r! Phone: 503.639.4171 Fax: 503.59 Plan Review Other Permit No.: Inspection Line: 5036394175 1I OF TIGARD D Re TIGARD . . Date Ready /By' �r ri ` , Ea See Page 2 for Internet: www.ti ard- or.gov BUILDING DIVISION Notified/Method: /. Supplemental Information ;;.; y i i'Y'PF OJ✓` WORK ' FEE* HEDUL E e y ; "` " m. . ' SC " ❑ New construction © Demolition For special information use checklist Description I Qty. I Ea. J Total Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection) ' CATEGORY , OF CONS , , TRUCT11)N SFR (I) bath 24910 i el 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building E] Multi-family SFR (3) bath 399.00 ❑ Master builder ❑ Other: Each additional bath/kitchen 45.00 r ire sprinkler q ft.) Page 2 . , F' spr'nkl r � s . ft. ,; . ' :JOB SITE. 11 ') k ' O1(N b.c M '1D I OCATION Si te utilities � Job site address: / 5 e ,/ l`d�7ip Gleek 2)"-, Catch basin or area drain 16.60 City /State/Z1P : Z Drywell, leach line, or trench drain 16,60 Suite/bldgiapt. no.: 72'5 ( Project name: /� // Footing drain (no. linear ft,: ___a Page 2 Cross street/directions to job site: Manufactured home utilities 110.00 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 ft.: _) 5C Page 2 / Fixture or item Tax map /parcel no.: Absorption valve 16.60 , DgS( Q1": WORk Back4ow preventcr Page 2 5 ) of L JZi sri.A t _, Backwater valve _ 16.60 Clothes washer 16.60 Dishwasher 16,60 D RQI; rERTX:.OWNER `T ❑.ENT Drinking fountain 16.60 NA Ejectors/sump 16.60 Name: Expansion tank 16.60 Address: Fixture/sewer cap 16.60 City /State/ZIP: Floor drain /floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal _ 16.60 * Hose bib 16.60 ❑ APFL1CANT El: CONTACT PERSON ,. ,, Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value; $ _) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain (commercial) � 16.60 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16 -60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 , s CONTJFACTOR _ �i. Water closet 16.60 .1,__ _s Business name: 6,7)4,1; ?14' yt5 ,716/.19 Water heater - 16.60 Address: Pd f 8? `� ) , Other: � p Subtotal City /State /ZIP: / „u /14 �� ^ q r? 91 - Minimum permit fcc: $72.50 Phone: ( ) )- 7t' _Fax: ( ) ea 3-. - Os (5 Residential backfiow minimum permit fee: $36.25 '7 _� CC13 Lie.: /(p q7 G'q Plumbing Lic. rto.: /-/,- F( `J Plan review (25% of permit fee) -t,� State surcharge of permit fee) '3- Authorized signature: TOTAL TAL PERMIT FEE x`, }J - Print name: t,/,`//4/ , ft; °5 41 I Date: This permit application expires if a permit is not obtained within Y °� -�� 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1; 113 uiIding \PemittPLMF- PertnitApp.doc 12127/06 440- 4616T(O0/O./COM/WED)