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Permit CITY OF TIGARD PLUMBING PERMIT �! . COMMUNITY DEVELOPMENT Permit #: PLM2011 -00146 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2011 • Parcel: 2S114DB00100 Jurisdiction: Site address: 17005 SW 92ND AVE Project: Cook Park Shelter & Bathroom Subdivision: Lot: Project Description: Installation of underslab utility lines for 20' each of sanitary sewer and water service. Sewer fees calculated under PLM2011- 00135. Contractor: BLAZER INDUSTRIES Owner: TIGARD, CITY OF PO BOX 489 13125 SW HALL BLVD AUMSVILLE, OR 97325 TIGARD, OR 97223 PHONE: 503 - 749 -1900 PHONE: FAX: 503 - 749 -3969 FEES Quantity Description Date Amount 20 If Sewer Service 05/10/2011 $62.54 Specifics: 20 If Water Service 05/10/2011 $62.54 1 12% State Surcharge - 05/10/2011 $15.01 Type of Use: COM Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $140.09 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 Notifi - . - - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direc .uestions to OUN• b ling 5e .232.1987 or 1.800.332.2344. Issue° By: L. . /� J-` Permittee Sig , , 1.44. Call 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. MAY -10 -2011 14 18 PUBLIC RESTROOM CO 775 +329 +2297 P.03 r1um1 AppICRAQI1 1.1 r N/. -..pi ` Site U t i l i t i e s I t I oil 1. h 1 i I I . \ .t i aty of Tigard ��� _ ,,. i 13125 SW 1 Dlvd., Tigard, OR 9 r L \\ �� � •'-� 44 //�QO �' I O Flom 303.7182+439 Fax: 503.598.1460 1® Mar No.: . Inyrcctiw Lino: 503.639,4175 0 0 ' la xww,tlgard-or.gov 1G 1 4 r' , 5o ' i ` ElliiERIE m16' � a i to `l- Ye i r y{ I• 1 rr is . i i : 1i j i i . yo ' i--,..,i cYL.id !< 3..w wVn� 1 �y.r ,r^l,. � ?',e �iI!�:1 ���'' �'• �1 • Now oonstructlon p Do ,1 tp For , • 1, a namiloa wr a ❑ Adilknlelteratfost/l�eplgct lnent 0 • Maori . ' on as r Toted d ?= Ad i 2 + rt,p ui•s� ? Ls'. rc ,� �. ?few 1- 2-fem8 dwcllin (ineloder100R, few each alit' eormestion) ;1 ,-..N 'uiu�'u+.c �} �: aut�`i :.� ;+.,L -� c ,4� ; a A 'yi; si (1)l>f#11 .11.11 31190 01- end 2- ihugy dwelling ' M= 437,18 CI A4:otbtaoty building © Multi -fi rnily R (3) bath 500.32 Bach additional taduldtxhan IIIII 25.02 ❑ MOW builder 0 Other; '�' �i- � waY TC -•�.r.�. �- �;Y�� �3 a�a „'6 N , � '� �' n Tiro 7prinld4T ( , eq. $.1 2 ? ' +'tg`R'� ., , c . 1 1 add MEN rl �1+ . 4-t?�1 , a .5 '. r z )' f 1_S ~�S�t a, SA5 ( 3�1 m: fib, v 1 ,: ." _ 51 t h u 11 ea! Job albs address: • pt C. h. • Oath basin Rena drain NM 18 76 Drgwoll, Icich lino, or Uoach drub 18.76 (i 9tatwZlP; l i _ ! '' 1/ Footing drain (no. limn' ft,: ) Page 2 14vJaot 17"4 ,ia.s .. L : , - + ' g! i, .g Mstrtlbcturcd home utiliiics 50.03 NM ■ Qom atroea/dlretdltlna to Job alto: _ ../ ' _ - martitoka 18.76 - Rain drela comtuotrn 18.76 IIIIIIIMIll Sanitary sow (no. linear R. :2 Page , _ , s I -., p. Sturm tower the. linear $.: Page 2 MOM Water service (no. linear 114= 11111 Pogo 2 tp 5 ' _ J Flxtarc or Item! 12.51 Baekfluw pi vco er r I � �. - '. : •P,... TT 4 +Y 1 t 1 *: .. , . , .7 . 1' ei�c7r. rgi r� , t+ t t : ?: -A!.;' ,S"-^ 13 x kwa tervahe ' t� :r k ' Ltd•` T el , l:.�I_a 1 t JS b r4 4t! n . l' y � , , Un:. '^ k' Y1Ji 4�slutia�::: ato3d�t�' �i1t `. %�� 3�, " " + 7 i Clotho washer 25.02 - . - - Z n 1 `+ : a _ ■ a . . rr Pi .. -f1 1 Diehw.sbvt 25.02 Drinking tbuateln 25,02 � _ i r>fectot. imp ME 2x.02 EMI IIdJ, .� t %1 7 . j r L"t�' 1 Yi F �� r Fr 6y . �7sl ` •' r Expansion t8nk vt. u +.::::vc-r.S -'v. L�i!*M .i r��1t L'. c!!3- r.•��'Y_•. 2Y �5� ���.�':7��� f L V Fixturpatwercup IM 25.02 N Garbage disp oar sinklhub 25.02 EMI Garbage diapwal 25.02 My/State/ZIP: Hose blb IIIIII 25,02' Ica maker 12.51 - i .ari S a 1 : } :1i :Jo, -� a 1 c 4' • I' interceptorfmut trap 2542 - � ra { '* Medical Bas (value:5,�,� ) KM Fdmer _ 12,51 Addreix: IF“ D `'' tzd , 6 C I ' ti _ Slnk/basin/lavahxy • 25.02 CifyfSt te/ZIP: t ' • L .,' F- Z1 Solar units (potable venter) 6234 MEM Phan: ( }v i , • • 0 �,��� � t Tub /shower/shower pen 12.51 la. Urinal 25.02 MIMI 4z,: Z r r:_,� iii . -s ue; _ i , , , , • Water *knot '�, rte o • it - �. � i�,. , <;,,:� ss.�l .. i.E-i: i ' 1t.c. u•,a, C t '° ( _ j:, : Y,' t • .i r.: �IN'0 5. Gf�,.:'. - -3 `Isp : �� .�'� r: •• Waterheatar Buab nee' & A 7 E 2 - ( 1 L US e W a r r 56,29 MIN Addteas f O 489 Other. 111111 25.02 City/Slide/ZIP: ArAMG ' off, co some / S.o;° Phone; • m $72.50 IZEN ( . .�) 7 MOD ������� Minimum fee: " ..: Plan review (24 %ofpermllfee) �' CCB Lia.: Soso - 3 : 4 '` State surcharge (12% of permit fee) � A l uthoriz � ed aimuatutot v' � -A/ ■ / 7 4 �k TOTAL PERMIT FEE -09 iRiiiii ii4i1♦, + Date: 5-id _I Th per mit upp ikition **tree It* permit It not *Malik within 160 dm *for it has bum accepted at cb ►Fos mdIadotoaysol by Tri-Couatr Hatldlug biduslrySaryioo Boa 11 6vIIdia811enoltAP1 .MU•PeoatiAlydoo 10.4109 440. alsT(Iala7M0AYWBe) ■ ■ TOTAL P.03