Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00238
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/22/2011
Parcel: 25111 AD08000
Jurisdiction: Tigard
Site address: 8880 SW SCHECKLA DR
Project: Rasmussen Subdivision: Lot:
Project Description: Replace 60' water service.
Contractor: CASEY'S PLUMBING Owner: RASMUSSEN, KURT
PO BOX 30075 8880 SW SCHECKLA DR
PORTLAND, OR 97294 TIGARD, OR 97224
PHONE: 503 PHONE: 503 - 516 -2451
FAX: 503 - 262 -8251
FEES
Quantity Description Date Amount
60 If Water Service 07/22/2011 $62.54
Specifics: 1 12% State Surcharge - 07/22/2011 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 07/22/2011 $9.96
Class of Work: ALT Plumbing
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:
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.
Jul 22 11 .12:51p Case's Plumbing 5032628251 p.1
Plumbing Permit Application
a te, , �„,; ��,
Building Fixtures N :.. FOR OFFICE USE ONLY
• 44 •
City of Tigard F; : "- " °` Re ceived ,*j 1e M/ Permit 2�Qk d/ D J/ 0
Plan Review
/
• 13125 SW Hall Blvd., Tigard, OR 97223 L 2 2 2011 Plan Review
1111 I Phone: 503.639.4171 Fax: 503.598.1 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 T n ;�y Date Ready/By: t �/ �� See Pa e 2 for
TIGARD Internet: www.tigard- or.gov CITY OF i 1 �C111� Notified/ ethod: 1 �j Supplemental Information
TYPE OF w8 DING DIVISION FEE* SCHEDULE
:w construction 0 Demolition For special information use checklist.
T Description I Qty. I Ea. I Total
p ddition/aiterationfreplacement ❑ Other: New I - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
- and 2- family dwelling ❑ CommerciaUindustrial SFR (2) bath 437.78
SFR (3) bath 500.32
b 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:
lob site address: ¢ Catch basin or area drain 18.76
(J� � 5 �� , � �` Drysvell, leach line, or trench drain 18.76
City /State /ZIP: \ L� + Ct Cla C\---\.--3 -
Footing drain (no. linear ft.: _� 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 1 8.76
Sanitary sewer (no. linear ft.: _____) Page 2
Storm sewer (no. linear ft.:, ) Page 2
Water service (no. linear ft.: ! Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
(te +� f Clothes washer 25.02
` - .0,,,A,) CC e (e'� 2r>rx t' C. - Dishwasher 25.02
�� �`- e' Drinking fountain 25.02
Ejectors /sump 25.02
OPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
� p�ct
Floor drain/floor sink/hub 25.02
C
Address: s5 ( --) %-\-1) \
r V11 Garbage disposal 25.02
City /State /ZIP: \.,a..._ct. C ' Ck'' \ I 4 Hose bib 25.02
Phone: (gZ) ' C9 - a 1 ,5- \ Fax: ( ) Ice maker 12.51
PLICANT
0 CON TACT PERSON Interceptor /grease trap 25.02
Medical ) Page 2
Business nom gas (value: S
` CLS(� Cs.f� l ,,,, Primer 12.51
Contact name: 'Z )- C OLS _
'�� Roof drain (commercial) 12.51
Address: r \_1 _ l _ c c, ? Sink/basin/lavatory 25.02
City/State /ZIP: Pc.�,- 1 a t C7 Q ck-1201 .. Solar units (potable water) 62.54
Phone: ( a��� -c��� Fax:: ( sc� ) a i tza -8�
? � Tub /shower /shower pan 12.51
�1
E -mail: , Urinal 25.02
�� �� ~� r � C C;t � PC \ _, , ,, \ ,, c cr,r, Water closet 25.02
CONTRACTOR
C Water beater 37.52
Business name: l f c i <) ' ? f
s_M \ Water piping/DWV 56.29
Address: C" X � l c5 Other:
�' � 25.02
City /State/ZIP: nr C ` C-1 2_9'4 Subtotal
Phone: (5Z) a ' _6 ,(, Fax: (,...6'2, ) _p t Minimum permit fee: $72.50 /21 S0
L�` ,...." Plumbing Lic. no.: a Lo = �zs ?� Plan review (25% of permit fee)
CCB Lic.: 1
State surcharge (12% of permit fee) , • 70
Authorized signature: t TOTAL PERMIT FEE
Print name: . c it LL1 e ci -k k e Date: '�,r . - 1 f This permit application expires if a permit is not obtained within 180 days
lL after it has been accepted as complete.
+ Fcc methodology set by Tri- County Building Industry Service Board.
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