Permit CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT Permit #: PLM2009-00281
Tip. Aikti� 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/14/2009
Parcel: 2S109AB15400
Jurisdiction: Tigard
Site address: 14165 SW ALPINE CREST WAY
Subdivision: ALPINE VIEW Lot: 35
Project: Alpine View
Project Description: Sanitary, storm and water service connections for sales trailer.
Owner: FEES
WEST HILLS DEVELOPMENT Quantity Description Date Amount
735 SW 158TH AVE
BEAVERTON, OR 97006 100 If Sewer Service 10/08/2009 $62.54
PHONE: 503-641-7342 100 If Storm and Rain Drain 10/08/2009 $62.54
100 If Water Service 10/08/2009 $62.54
1 12% State Surcharge - 10/08/2009 $22.51
Contractor: Plumbing
DEVELOPMENT NORTHWEST INC
1075 W. COLUMBIA RIVER HWY
TROUTDALE, OR 97060
PHONE: 503 - 667 -1781
FAX: 503- 667 -9891
Type of Use: CMS
Class of Work: NEW Type of Const:
Occupancy Grp:
Stories:
Total $210.13
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 Notifica '•- "- - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct •.estions to OUNC . calling 503.246.6699 or 1.800.332.2344.
•
Iss ed By: / Permittee Signatur: /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Applic
II
. FOR OFFICE USE ONLY
City of Tigard R •
.. Date/By: � ff, / Permit No.. I , /�-� JQ i 4 , ` /) ' /
Plan Review LI ` /1 � IC ��
a 13125 SW Hall Blvd., Tigard, OR. 97223
Date/By- Other Permits. • �/ (n
O Phone: 503.639.4171 Fax:�0- .5481960109 Y
Date Ready /By: 13 See Page 2 For
/" Inspection Line: 503.639.4175 Notified /Method. Jens Supplemental Information
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TYPC�F FEE *"SCHEDULE
0 New construction ❑ Demolition For special information use checklist
ID Addition /alteration /replacement ❑ Other: Description Qty. I Ea. I Total
New 1 -2 family dwellings (includes 100ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
Q 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder El Other: Each additional bath/kitchen 45.00
Fire sprinkler (4 sq. ft.) Page 2
JOB "SITE INFORMATION AND LOCATION
Site utilities
Job site address: 14165 SW Alpine Crest Way Catch basin or area drain 16.60
City /State /ZIP: TIGARD, OR. 97224 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt.no.: i Project name: Footing drain (no. linear ft.' ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary.sewer (no. linear ft.: /Dn) Page 2 0,...5
Storm sewer (no linear ft.: 10.421 Page 2 64
Water service (no. linear ft.: /Dal Page 2 62a
Subdivision: ALPINE VIEW I Lot no.: 35 Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
SALES TRAILER Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
El PROPERTY OWNER I ❑ TENANT ' Ejectors /sump 16.60
Name: WEST HILLS DEVELOPMENT Expansion tank 16.60
Fixture /sewer cap 16.60
Address: 735 SW 158th AVE Floor drain /floor sink/hub 16.60
City /State /ZIP: BEAVERTON, OR. 97006 Garbage disposal 16.60
Phone: ( 503 ) 641 -7342 Fax: ( 503) 641 -7661 Hose bib 16.60
El APPLICANT El CONTACT PERSON " Ice maker 16 60
Interceptor /grease trap 16 60
Business Name: WEST HILLS DEVELOPMENT Medical gas (value: $ ) Paget
Contact Name: ANGIE COOK Primer 16.60
Address: 735 SW 158th AVE Roof drain (commercial) 16.60
City /State /ZIP: BEAVERTON, OR. 97006 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
Phone: ( 503 ) 726 - 7042 Fax: ( 503 ) 641 - 7661
Urinal 16.60
E - mail: acook @arborhomes.com Water closet 16.60
CONTRACTOR Water heater 16.60
Business Name: DEVELOPMENT NORTHWEST (WOLCOTT PLUMBING) Other:
Subtotal
Address: 1075 W. HISTORIC COLUMBIA RIVER HIGHWAY
Minimum permit fee $72.50 ��
City /State /ZIP: TROUTDALE, OR. 97060 Residential backtlow minimum permit fee: $36.25 1(7•
Phone: ( 503 ) 667 -1781 Fax: ( 503 ) 667 -9891 Plan review (25% of permit fee) $
CCB lie.: 112220 Plumbing Lic. no.: 26 -824 PB State surcharge (12% of permit fee) .57
Authorized TOTAL PERMIT FEE alo, 1 3
�� � $ This permit application expires if a permit is not obtained with
signature: (Kr
180 days after it has been accepted as complete.
I Print name: GARY LIPPOLD I Date: 10/2/2009
* Fee methodology set by TO-County Building Industry Service Board
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