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Permit r '7 CITY OF TIGARD PLUMBING PERMIT 31111 0 , - COMMUNITY DEVELOPMEN Permit #: PLM2009 -00052 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/11/2009 Parcel: 25111 DC14300 Jurisdiction: Tigard Site address: 9165 SW DURHAM RD Subdivision: Lot: 0 Project: Smith Project Description: Replace 100 ft water service. Owner: FEES SMITH, CAROL A Quantity Description Date Amount 9165 SW DURHAM RD TIGARD, OR 97223 100 If Water Service 03/10/2009 $55.00 PHONE: 1 12% State Surcharge - 03/10/2009 $8.70 Plumbing 18 ea Minimum Fee Adjustment - 03/10/2009 $17.50 Contractor: Plumbing AMERICAN RESIDENTIAL SERVICES LLC P.O. BOX 2830 CLACKAMAS, OR 97015 PHONE: 503 - 235 -8784 FAX: 503 - 491 -2932 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: 2 I ,.... 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. A ? ?G -10 - ;004 21:04 RECEIVED P.001 Plumbing, Permit Application Building Fixtures MAR 0 9 2009 FOR (TFFICF. USE ONE City of Tigard CITY OF TIGARD Rece � K Ti • 1 Permit No r • N 13125 SW vd,. gad, O Plan Ct,CU •O P ss „C� • 9 Phone: 503 Hall Bl 41 �I Fax r 503.598. 972LDING DIVISIOI Plan .. Other Permit No Inspection Line 503 639.417: TIGARD DaleRead> By: a See Page: 0,r Internet' wwtv.ligard- or.gov Nuufled,Method' SupptementallnFormaGon TYPE OF WORK FEE SCHEDULE 0 New ei nstrucl ion ❑ Demolition For_speeial information use check list. Description I O' I Ea. I ptAl OAddition /ulterulion /replucement El Other; Nev. 1.2- family dwellings (includes 100 R. for each utility cnnnectina,) CATEGORY OF CONSTRUCTION SFR I I i bath 249.20 A 1 - and 2 - family dwelling ❑ Commercial /industrial SFR (21 bath 350.00 El Accessory building ❑ Multi - family SFR (31 bath 3yy - ❑ Master builder ©Other: Each additional bath/kitchen 45.00 Fire sprinkler I sq. ft, I Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Z1/4 !/7 Catch basin or area drain 16.60 '�i g g7 Dowell, leach line, or trench drain 16.60 r�y� Footing drain (no. linear ft.': _ ) Page 2 MIN Suite/bldg./apt. no.: Project name: ;} • r ►. � g - Manufactured home utilities 110.00 Cross street /directions to job site: .. Manholes IIII 16.60 Rain drain connector 16.60 Sanitary sewer no. linear fi.: _) Page 2 Storm sewer (no. linear t}.. ) Page 2 IIIIIIIMI Subdivision:: Lot no.: Water service (no. linear ft.: it►t MI Page 2 Tax map /parcel no.: Fixture or item DESCRIPTION OF WO t K Absorption vibe t 6.60 ,.� el./ Backflow pi Page 2 1/ • 41Y_ `� - Backwater valve 111 16.60 (�f+,, 'J "' Clothes washer 16,60 '� `� Dishwasher 16.60 ]� Drinking fountain - 16.60 {a 1'i�OPF:I'2,�1'�Y OWNER � ❑ TENANT [3jecturs /sump 16,60 Name. % Expansion tank - 16.60 Address:/ /• . .11 &OA _ Fixture /sewer cap - 16.60 • City /State /ZIP 177"2 (< < � Floor drain/floor sink/hub 16.60 �: ` disposal Phone: ( ) aV( ) Garbage osal c 8 p 16.60 A t APPLICANT CONTACT PERSON Hose bib 16,60 Business name: ARS dba JACK HOWK /Rescue Rooter . / Iec maker 16 0 - Interceptor /grease trap 16.60 Contact name: JOYCE DENNIS ' Medical gas (value: $ ) Page 2 Address: P.O. BOX 2830 Primer 16.60 - City /State/ZIP: CLACKAMAS, OR 97015 Roof drain (commercial) 16.60 Phone: (503) 235 -8784 Fax:: (503) 491 -2932 Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E - mail: JOYCE( JACKHOWK.COM Urinal - 16.60 CONTRACTOR Ri i e C cox Q. , i,cti,"\- Nr'atcr closet - 16,60 Business name: ARS dba JACK HOWK /Rescue Rooter O-12.(v • C.Q. LAC Water heater 1 6.60 Address: P.O. BOX 2830 - Other: City/State/ZIP: CLACIGAMAS, OR 97015 Subtotal Minimum permit fee: $72.50 Phone: (503) 235 -8784 Fax: (503) 491••2932 Residential baekflow minimum permit fee: $36.25 ~0, r1 i CCB Lie.: 127325 1 • 2 Li • 4 .1 Plumbing Lie. no.: 34 - 168 P Plan review (25% of permit fee) MI Authorized signature: --/ • t - t‘ State surcharge 02% of permit fee) IR,W /�j r �, l TOTAL PERMIT t _�i IF/ Print name: � /` �� / s �� This permit application expires if a permit is not o ' P " "" 180 days after it has been accepted as complete. -41 , 'Pee methodology set by Tri -County Building Industry Service Board. t' \BuItlira,Permi181PLm -Y. Please FAX .BAC 1 7 S03- 491 -2932