Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00160
Date Issued: 05/20/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S102DD00809
Jurisdiction: Tigard
Site address: 13940 SW 87TH CT
Project: Gardner Subdivision: FILBERT PARK Lot: 2
Project Description: Replace gas water heater
Contractor: PIONEER GAS FURNACE Owner: GARDNER, RICHARD A
2636 NE SANDY BLVD 13940 SW 87TH CT
PORTLAND, OR 97232 TIGARD, OR 97223
PHONE: 503 - 639 -9307
HONE: 503 - 249 -5000
FAX: 503 - 249 -8260
FEES
Quantity Description Date Amount
1 ea Water Heater 05/20/2011 $37.52
Specifics: 1 12% State Surcharge - 05/20/2011 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 05/20/2011 $34.98
Type of Use: SF 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: Permittee Signature: �� e9.70.- /o9-7-7e1 ,e,5544.,x),_c__
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 20 2011 10:16RM HP LRSERJET FRX p.4
Plumbing Permit Application v .`
Site Utilities ? � 1 . I ( ,i� OF I I`t I. I :I )�1.l
City of Tigard ci R e cei v aa Dat ' iii
Permit
� n _ / • Peit No.
�- 41 13125 SW Halt Blvd., Tigard, OR 97223 \V,� e/B ��/ P �� O ��� ��� 4, Phone: 503.7!8.2439 Fax: 503.598.{960 c 11.,911,* tan
1 I \`? MV.e/By Other Permit No.:
Inspection Line: 503.639.4175 OA 1 ®r 0,.N11C i•p y: Page 2 for
i t •?• i< l`. IaateaiCt: w ww.ti d- or.gov
t
n��
� )1e \`! Notified/Method: Information
❑ New construction ❑ Demolition _ For special information use checkiist
.KAddition/alteration/re lacernent dwellings (includes 1
�� '�'i: > :' `- : i '� ;
Desert e 2-family
312.70
l- and 2-family Y � ( c u es 00 ft. for each utility connection)
P
. ..�: •- : - :: • :. . - '�' � � (
1 i d in r in h ut'lity corm an
SFR 1)
dwelling c SFR (2) bath 437.78
y g ❑ Commercial/industrial
❑ Accessory building ❑ Multi- family SFR (3) bath 500
Each additional bath/kitchen 25.02
0 Master builder , ' ❑ Other:
r, :a„ : ! .... . Fire sprinkler ( sq. tt) Page 2
_ _ :- .,,,i
... -,. .8, E' + :A : O '.,:: ikr Site utilities:
Job site address: `Rtib s.) ` ' Ci� • Catch basin or area drain 18.76
(� ` O R 9 7 / Fo o! leach line, l or trench drain 18.76 _
?
CitylState/ZIP: I tQ�/? ` y ` _ / '•7 C� Footing ling drain (no. linear fl.: ) Page 2
Suite/bldg. /apt no.: 1 Project name:
.494,.-- Manufactured home utilities 50.03
Crass 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.: ) 1 Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.:
Backflow pre venter 31.27
".. Backwater valve 12.51
1 1 1 ,11 , e +, _ `� � J _ eEpC Mwr Dishwasher 25.62 25.02 AO j �j�t�/ 'CGC('�i� Dishwasher 25,02
Drinking fountain 25.02
Ejectors/sump 25.02
?.i, ': `E',1Y ,;. >;...:: 7 ❑?,- . ' Expansion lank 12.51
Fixture/sewer cap 25.02
Name: kieA' f j (qa ./" 0. ./' •
` ,39 it Tit) t . g - 7 , CI' + •
Garbage disposal sink/hub 25.02
Address: 6 UtJ tfL~' Garbage disposal 25.002
City/State /ZIP: eak 1 72.j. Hose bib . 25.02
Phone: cg !2i - 4 730 7 Fax: ( ) Ice maker 12.51
IC AS ` . COuTrAL&P
1:: >;:r:.;� ....:.:......... ,� ' ..., . iQ PEitl�P£!P n ceptgrlgrPAC
.... �`:� .. -. ' 1 ter trap 25.02 e
Business name:
Medical gas (valud: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) . 12.51
Address: Sink/basin/lavatory 1 . 25.02
City /State/ZIP: y Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail:
• Urinal 25.02
Water closet 25.02
cliirCItirgi
Water heater /
°...;:,- ...:,.. ., ..... ... 37.52
Business name: i f Q.Ct ifourrzW Water PP g!
I in DWV , 56.29 •
j l t
Address: 2.49 6, /J S/r yY7 r 4jd_ Other. 2 5.02
City / State/ZIP: # "" 6& 732.. , • • Subtotal
y4 / /� Minimum permit fee: $7 fee) ,,a
Phone:�� ). �.•'�Q ` SQ F �) �� `/ /q 2 �w 5.� p
f„ , ,ECB Lic.: / 73 J f j✓� J7 / /o_Plumbing Lic. no.: a6 - 6 f ph, Plan review (25 °!° of permit fee}
u p� � (y State surcharge (12% of permit fee) A g- 7o
Authorized signature:: -7/1/1 f - V'! " TOTAL PERMIT FEli ,Z.40 // '� �` This permit application expires if a permit is not obtained within ISO days +✓
Print name ,..
7 Dat r/ after it has been accepted as complete.
fff `Fee methodology set by Tri- County Building Industry Service Board.
L• mauildrngVermrtsl?LM11- IermiLApp dec ID/n1/09 440- 4616T( 10/02/COM/WEB)