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Permit
CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 -00305 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Date Issued: 10/07/2011 Parcel: 2S102BB00811 Jurisdiction: Tigard Site address: 10270 SW BROOKSIDE PL Project: Hermanson Subdivision: BROOKSIDE PARK Lot: 5 Project Description: Replace 50 ft of water service Contractor: APOLLO DRAIN & ROOTER SERVICE Owner: HERMANSON, CHRISTOPHER ALLEN 2208 NW BIRDSDALE #8 10270 SW BROOKSIDE PL GRESHAM, OR 97030 TIGARD, OR 97223 PHONE: 503 - 239 -8801 PHONE FAX: 503 - 669 -9568 FEES Quantity Description Date Amount 50 If Water Service 10/07/2011 $62 54 Specifics: 1 12% State Surcharge - 10/07/2011 $8 70 Plumbing 10 ea Minimum Fee Adjustment - 10/07/2011 $9 96 Type of Use SF Plumbing 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 II work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, . if work is . .ended for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility otification Center. .se r - are set forth in OAR 952 - 001 -0010 through OAR 952-00141'0 You may obtain a copy of the rules or dir-ct questions to OUNC by c- ng 50 . 987 or 1 800 332 2344 Iss ed By: / / Permittee Si. nature: Call 503.639.4175 by 7:00 a.m. for the next available inspe on 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. Oct. 6. 2011 3:53PM No, 8988 P. 1 Plumbing Permit Appliea>� of hli Building Fixtures OCT 0 6 2011 , , . . F,OR imfi It b ONLY City of Tigard Received 7 + 13125 SW Hall Blvd Tigard CITY OF TEGAiZD DaleB •. l0 / Permit No„ / /�� • ��Q��}} DIVISION Review ' Phone, 503,718 2439 Fax:'-583I CN DoteB Other I'ernul No. TIGARD Inspection Line, 503 639 4175 Date Reody/By Juno El See Pa e 2 for Internet' wwwtigard- or,gov Notified/Method: Supplemental Information TYPE OF WORK FEET SCREDULE For special information use epeck list. ❑ New constntction ❑Demolition r T Description Ow. I Ea, I Total 1 Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 h. for each utility CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 SFR (2) bath 437.78 '.l 1- and 2- family dwelling ❑ Commercial /industrial SFR (3) bath 500,32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25,02 ❑ Master builder ❑ Other: Fire sprinkler ( sq, 0.) Page 2 w JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: + '..") ...... i+ + � ( � r , i Catch basin or area drain 18.76 Drywell. leach line, or trench drain 18 76 City /State /ZIP: G1.1�.- O C;: 1 D Fooling drain (no linear ft• �) Page 2 Suite /bldgJapt. n,,: Project name: Manufactured home utilities 50 03 Cross street/directions to job site: Manholes 18 76 Rain drain connector 18,76 Sanitary sewer (no. linear ft. ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft..c0) ( Paee 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no : Backflow preventcr ' 31.27 Backwater valve 12,51 . DESCRIPTION OF WORK i / ` Clothes washer 25,02 .- . (AD • �.at. Dishwasher 25.02 Ae - • • _ Drinking fountain , 25.02 Ejectors /sump 25 02 ' = PROPERTY OWNER 0j TENANT Expansion tank 12.5 l Y Fixture /sewer cap 25.02 Name: ! r A _ a 41 !L' - ' AAft Floor drain/floor sink/Itub 25,02 Address: - Garbage disposal 25,02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT © CONTACT PERSON Interceptor /grease trap 25 02 Business name: APOLLO DRAN & ROOTER SERVICE INC. Medical gas (value. $ ) Page 2 Contact name: CHRISTINE KAPEL Pruner 12.51 Roof drain (commercial) 12,51 Address: 2208 NW BIRDSDALE # 8 Sink/basin/lavatory 25,02 City /State /ZIP: GRESHAM OREGON 97030 Solar units (potable water) 62.54 Phone: (503 - 2398801) Fax: : (503. 669 -9568) Tub /shower /shower pan 12 51 E -mail: CHRISTINE POLLODRAIN.CO\I Urinal 25 02 r, Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: APOLLO DRAN & ROOTER SERVICE INC. Water piping/DRN 56,29 Address: 2208 NW BIRDSDALE # 8 Other, 25.02 City/Stale/ZIP: GRESHAM OREGON 97030 Subtotal Phone: (503 -239 -8801) Fax: (503- 669.9568) Minimum pcmtit fee' SP -.50 a.Q - CCB Lie.: 49418 A ' umbing Lic. n.: -533PB Plan review (25% of permit fcc) - g ��` � i `� / State surcharge of permit fee) / .70 Authorized signor �i TOTAL TAL PERMIT FEE v . Print name: CHRISTINE ICAFEL Date U min This permit application expires if a permit i$ nor Obtained within 180 days after it has been accepted ps complete. 'Fee methodology set by Tri- County Building Industry Service Board, I \2uddm0iPorvJ s\l'LOtl/ PcrmitApa doc 10/01/09 l40- 461fiT(l0 /02/COM/WEB)