Permit � e
= CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00293
lbA D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/16/2009
Parcel: 2S111CC04600
Jurisdiction: Tigard
Site address: 15980 SW CENTURY OAK CIR
Subdivision: Lot: 0
Project: Beamish
Project Description: Repipe 2 story house.
Owner: FEES
BEAMISH, ALICE F Quantity Description Date Amount
15980 SW CENTURY OAK CIR
TIGARD, OR 97224 3 ea Hose Bib 10/16/2009 $75.06
PHONE: 503-684-8258 2 ea Lavatories 10/16/2009 $50.04
1 ea Tub /Shower /Shower Pan 10/16/2009 $12.51
2 ea Water Closet 10/16/2009 $50.04
Contractor: 1 ea Water Heater 10/16/2009 $37.52
CASEY'S PLUMBING 1 12% State Surcharge - 10/16/2009 $27.02
P.O. BOX 30075 Plumbing
PORTLAND, OR 97294
PHONE: 503 - 253 -0030
FAX: 503 - 262 -8251
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories: 2
Total $252.19
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 ion Cente . 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 uestions to DUN* , ■ ca 'ng 503.246.6699 or 1.800.332.2344. /^
Issu d By: / tiO 4 I 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.
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Oct 15 09 10:02a Case's Plumbing 5032628251 p.2
-.,, .
Plumbing Permit Application •
Building Fixtures RECEIVED
Received FOR OFFICE USE ONLY
City of Tigard d � Q 1 �` 2
}y g ive / A Permit No.: C./! � ` � m/p�� ' en
`J Date/By: jp/A* /�* �7K
r 13125 SW Hall Blvd., Tigard, OR 97223 5 ?OO Plan Review jjj
s - Phone: 503.639.4171 Fax: 503.598.l K j 1
Date/By: Other Permit No.:
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TIGARD Inspection Line: 503.639.4175 A pr Date Ready /By: 1 ® ^ See Page 2 for
Internet: www.tigard or.gov OVVIG Notified/Method: /! r Supplemental Information
TYPE OF IV 1 f lNGD1\1S1- FEE* SCHEDULE
❑ New construction D emolition For special information use checklist
Description i Qty. I Ea. I Total
c..ya ddition/alteration/replacemenf ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
SFR (1) bath 249.20
CATEGORY OF CONSTRUCTION
�.Y- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399,00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: '�'::\ $O
""---- -.:•+ \-■,)--7 GC,`1( ( 0,.Q Catch basin or area drain 16.60
City/State/ZIP: '�- Drywell, leach line, or trench drain 16.60
t Footing drain (no. linear ft.: ) Paae 2
Suite/bldg. /apt- no.: Project name:
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
“Na , _ (' i L{r� - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.' ) Page 2
Fixture or item
Tax snap /parcel no.:
Absorption valve 16 60
DESCRIPTION OF WORK Backflow preventcr Page 2
�{{��� ,` Backwater valve 16.60
rt— Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
y4ROPERTY OWNER ❑ TENANT
Ejectors /sump 16.60
Name: ` � . I , -N- \. /N Expansion tank 16.60
L
Address: ` � � : C A, . C? v'1'CLk_V1 4 v Fixture /sewer cap 16.60
City /State /ZIP:
-----;\: f iNA, C-, -\coma` Floor drain /floorsink/hub 16.60
Phone: ( U",,% ' t t'- Fax: ( ) `l Garbage disposal 16.60
Hose bib 3 xs 7504
❑ A3PLIC NT 1 ❑ CONTACT PERSON
Ice maker I 16.60
Business name: S .kv,,Y\-c-
Interceptor /grease trap 16.60
Contact name: -L� C- Medical gas (value: $ ) Page 2
Address: '.c_) • R CX71- Primer 16.60
City /State /ZIP: '.;,r--qcis-,A_ t C2_ c_.\—i 2v4 Roof drain (commercial) 16.60
'� Fax:: Sink/basin/lavatory c,:? 2' _ §_o #._-
Phone:
(- - ') ' � ( �) a( `a - 6 Tub /shower /shower pan 1 /90 .o0 /2.6/
E -mail: CCir.ACiLA-( C_a_ ,-i i un`\j;yt CCjr-.R Urinal 16.60
CONTRACTOR Water closet A 540•0.f
Business name: ' • ' . 'S '<'lt-.u'1'l1o=v-1-. Water heater I 3/ 37.5''
Address: ` C) X �3C)C3 Other:
Cj�4 \, Cti LCA �� - t
City/State/ZIP: o � permit Subtotal
j Minimum peit fee: $7250 n e f .�
1
Phone: (rs ) a3-3- 003e Fax: ( ) a LoD_$�•, _ Residential backflow permit fee: 536.25 225
CCB Lie.: ! "`1' 0. t7 Plumbing Lie. no.: . 12 g �� Plan review (25 %ofpermit fec) ...—
Authorized signatu n n State surcharge (12% of permit fee) a 7.02. k� C" \^ � ] TOTAL PERMIT FEE A:;9 r , I a
Print name: lAt;tn1 1LCe d+ke�. Date: ltd r 1, This permit application expires if a permit is not obtaine with
I 4 180 days after it has been accepted as complete.
I *Fee methodology set by Tri -County Building Industry Service Board.
1a BuildinglPermilstPLME- PermitApp,doe 1 2/27)06 440- 4616T(101021CaMEB)
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