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Permit 4? CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009-00310 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2009 TI CARD Parcel: 25111 CC01900 Jurisdiction: Tigard Site address: 10325 SW CENTURY OAK DR Subdivision: Lot: 0 Project: Howard Project Description: Replace all interior water piping. Owner: FEES HOWARD, RICHARD Quantity Description Date Amount 10325 SW CENTURY OAK DR TIGARD, OR 97224 1 ea Water Piping 10/27/2009 $56.29 1 12% State Surcharge - 10/27/2009 $8.70 PHONE: Plumbing 16 ea Minimum Fee Adjustment - 10/27/2009 $16.21 Plumbing Contractor: PIPELINE PLUMBING PO BOX V -108, 333 S STATE ST LAKE OSWEGO, OR 97034 PHONE: 503 - 624 -1906 FAX: 503 - 624 -1926 Type of Use: SF 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: em / //-p n L / /C — 1 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. ,. RI. . R ECEI V bl ���„JJJ YYY p.1 6 2009 i I 11. 11 r Plumbing Permit Application �C� 2 ;` �� .- hiding Fixtures CIIN OFD ISION • FOR OFFIC t1SL • ONLY. . City of Tigard gUILD Received 1114 Dato/By: lt`A0 f 45044--' PcnnitNo.P 0ZOo O.. 3�0 + 13 125 SW Hall Blvd., Tigard, OR 97223 Plan Review/ l _ Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: Tf G:\ It Q Inspection Line: 503.639.4175 Date Ready/By: J H Sec Page 2 for lA1L [ .7:;A11 ,Anil _t�._iD:_ l,' I ;i_:- ' LI❑:: :: Notified/Method: C? SupplementaIIuEonnation TYPE OF WORK I • FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description k Qty. I Ea. I Total , ddition/alteration/replaccment ❑ Other. New I -2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION • SFR (1) bath 312.70 ,01- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ 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: : St.� . • OA IL / Catch basin or area drain 18.76 Job site address l (i ��`� f t i CitylStatelZII': T, t' ' 3,..D Drywcll, leach line, or trench drain 1836 �t C� ( J Footing drain (no. linear R: __) Page 2 Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 I /k ' _ 2/ 1 -1 n A. I _ - fa et_., • Rain drain connector 18.76 • Sanitary sewer (no. linear ft.: ) Page 2 O� C`cL'fl /rrT 1 1c) ()mi.- ' Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear It.: ) Page 2 I Subdivision: Lot no.: ' Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer • 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51 1 Fixture /sewer cap 25.02 Name: a 12 . � ,� 1e / efT ./1'/[,6 Floor drain floor sink/hub 25.02 Address: � ,y _� ,, - � 'i / -/ E __ Garbage disposal 25.02 City /State/ZIP: Hose bib { 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ____ ❑ CONTACT PERSON Interceptor /grease trap t, 25.02 Business name: 2 1- 1 f.-1 24= r 17 �� Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: itl _ 0 , -4 ` Roof drain (commercial) 12.51 Address: S. S. �f le S _ StJ L�� V y � I Sink/basin/lavatory 25.02 City /State/ZIP: LC.lrk( . �. jc , , r c . a. , cl :(4 Solar units (potable water) 62.54 Phone: ( 5 ) (J Lj- k C v� Fat:: ( ) �j� - f C a Tub/shower/shower pan 12.51 E -mail: Urinal 25.02 k �1 n �dIAfYl�ik C ° � (/ y � ZiJ � Water closet 25.02 CO Water heater 37.52 Business name: i ', j, I � e f w - r sb n.5 Water piping#DWV 1 56.29 Address: �!� . . - ' .a G%l._koN.L - Other. • . 25.02 City /State/ZIP: .., Subtotal P,honc: ( ) ' Fax: ( ) ` Mininlumpcmait fee: $72.50 -7 a ,sa r Plan review (25% of permit fee) ' CCB Lic.: t`- O Plumbing Lic. no.: .3 1©- e& , 7 d t "'` -'iv N (� ,1 State surcharge (12% of permit fee) Authorized signature: r - ' - f '3 -5 I P,, ill 1' TOTAL PERMIT FEE r i ,, ✓ This permit application expires if a permit is not obtained within 180 days Print name: I .�^ i RI j Dale: I 0 c ��p t after it has been accepted ns complete. (� *Fee methodology sat by Tri- Couuty Building Industry Service Board. t: auildins'tPermitsLPLMU- 1'orrnit App.doc 15,01109 440451 ST(10 /02/COht+wEl11 •