Permit t q
CITY OF TIGARD PLUMBING PERMIT
: COMMUNITY DEVELOPMENT Permit #: PLM2009-00131
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/29/2009
TIGARD 13125 25101 DCO2900
Jurisdiction: Tigard
Site address: 7595 SW CHERRY DR
Subdivision: Lot: 0
Project: Chick
Project Description: Replace up to 100 feet of water service.
Owner: FEES
CHICK, MARIBETH A Quantity Description Date Amount
11575 SW PACIFIC HWY, PMB #120
TIGARD, OR 97223 100 If Water Service 05/29/2009 $55.00
PHONE: 1 12% State Surcharge - 05/29/2009 $8.70
Plumbing
18 ea Minimum Fee Adjustment - 05/29/2009 $17.50
Plumbing
Contractor:
D & F PLUMBING
4636 N ALBINA AVE
PORTLAND, OR 97217
PHONE: 503 - 282 -0993
FAX: 503 - 288 -0604
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: �^ ^ ( A ��� ^
r► •�1 • ! L.1 App r l
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.
Mav 29 09 02:39p D & F PLUMBING 503 - 288 -0604 p.1
i 1.1.11.1111,1,111.g. Gi MIL H.ppllcanon
Building Fixtures RECEIVED
FOR OFFICE USE ONLY ,
City of Tigard v q 2009
M q il Received
Permit 13125 SW Hall Blvd., Tigard, OR 97223 Mg Gt 9 �1clBy: Qr� � '
Phone: 503.639.4171 Fax: 503.598.1960 p Plan Review L • v
Inspection Line: 503.639.4175 .�+�/ Ti_ ARD Date/By: Other Permit No.:
TIGARD OF Date Ready/By: ]uri5;
Internet: www.ti CITY [VIS
Noti fiedlMethod: &I SecPage
TYPE OF WO C7 Supplemenrat Information
FEE* SCHEDULE
ew constructi . m olition DING For special injorrrrutiou use checklist
D -
[] N XAddition /alteration /replacement Description Qty, Ea. Total _
❑ Other: New 1 -2- family dwellings (includes 100 11. for each utility connection)
CATEGORY OF CONSTRUCTION ' ' SFR (1) bath
.p(l -and 2- family dwelling 249.20
❑ ComntercialllndustriaE SFR (2) bath 350.00
. ❑ Accessory building ❑ Mufti - fancily SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder 0 Other:
JOB SIT£ INFORMATION AND LOCATION Fire sprinkler ( sq. &) Page 2
Site utilities
Job site address:
75-9c- O � 1 N' y • Catch basin or area drain 16.60
City/State/ZIP: .77 6 7 6 Drywell, each line, or trench drain
16.60
Suitetildg.iapt. no.: Project name: go- �� �i�� /Gl� Footing drain (no. linear ft. ) Page 2
Cross strcetldirections to job site: Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector ]6.60
Sanitary sewer (no. linear ft.: ..) Page 2
Storm sewer (no. linear ft.: J Page 2
Subdivision: l Lot no.: Water service (no. linear ft.: 1/J ) i Page 2
Tax map/parcel no.: Fixture or item
DESCRIPTION OF • WORK Absorption valve 16.60
� � _ /� Backflowpreventer Page2
~ ->? - / " ` ' ' ` , - L f r 2 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
El PROPERTY OWNER . I ❑ TENANT Drinking fountain 16.60
Name: Ejectors/sump 16.60 '
Address: Expansion tank 16.60
Fixture/sewer cap 16.60
City/State/ZIP:
Floor drain /floor sink /hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
• ❑' CONTACT. PERSON Hose bib 16.60
• ❑ APPLICANT
Business name: Ice maker 16.60
Contact name: Interceptor/grease trap 16.60
Address:
Medical gas (value: $ )
Page 2
Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) F ax: ; ( ) Sinkibasinllavatory 16.60
E-mail: Tub /shower /shower pan
16.60
•
Urinal 16.60
CONTRACTOR •
Water closet 16.60
Business name: y °
pi'� �I'yC:�
Water heater 16.60
Address: �/_ ' j m _, » Ave . Other:
City/State/ZIP:: p yr -'• /7r g 7P,-
�jvt ���� h" °/ � 1 Subtotal
P ne: ( ) L p (/7_ Fax: ( ) Minimum permit foe: $72.50 - z 0 •� �/ Residential backflow minimum permit fee: $36.25
GCB Lic.: ‘j S 1 • . 1 0 Plumbing Lie. no.:2L_.L3 Pe, Plan review (25% of permit fee)
Authorized signature: A i/f �, (` State surcharge (12 %ofpermit fee) (�' ••c}
i /L, TOTAL PERMIT FEE
g^-�' �j This ` within
Print name:
j�1� � �✓� � ( � j Date: �"_�l c .9 � s permit application expires if a permit is not obtained n
180 days after it bas been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
iisaainga •crmitopts4?- Permitnppeo 12/27/06
440 4616T(10/07.1COM/WEB)