Permit CITY OF TIGARD PLUMBING PERMIT
11111 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00313
Date Issued: 10/21/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S112CA08700
Jurisdiction: Tigard
Site address: 7556 SW ASHFORD ST
Project: Takasumi Subdivision: RENAISSANCE WOODS Lot: 13
Project Description: Replacement of less than 100' of water service Note: Electrical permit is required if replacement piping effects
house grounding.
Contractor: CASEY'S PLUMBING Owner: TAKASUMI, RICHARD C & DEANNE L
PO BOX 30075 7556 SW ASHFORD ST
PORTLAND, OR 97294 TIGARD, OR 97223
PHONE. 503 - 624 -1183
HONE. 503 - 253 -0030
FAX: 503 - 262 -8251
FEES
Quantity Description Date Amount
100 If Water Service 10/21/2011 $62.54
Specifics: 1 12% State Surcharge - 10/21/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 10/21/2011 $9 96
Plumbing
Class of Work: OTR
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 s 'cation terrtet. Those rules are set forth in OAR 952-001-0010 throu h OAR •5 -O! :: °: ou may obtain a copy of the rules
or d —et questions to OUN• by 'g 50 232 1987 or 1 800 332.2344. C/ /
Iss ed By: /4 Permittee Si
`
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Call 503.639.4175 by 7:00 a.m. for the next available inspection 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.
Pecmi( 21 11 07:31a Case's Plumbing 5032G28251 p.
Plumbin Permit App ` %V.
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Building Fixtures FOR OFFICE USE ONL
OCT 21 2011 L
City of Tigard 4. // nz,
ReceDa[eB 4 8/ 1,, ived Fl �/�
NO 7 I
13125 SW Hall Blvd., Tigard OR 7 ,2 Plan Review
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Phone: 503 - 639.4171 F 1 13." I �� p a � Date/By: Other Permit No:
TIGARD Inspection Line: 503.63 1tZg fl DIVISION Date Ready/By: runs El See Page 2 for
Internet: wt�w.t or. -- Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ DemoIition For special information use checklist.
7? ddition/alteration/replacement Description Qty. Ea Total
❑Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
)- 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:
Job site address: Catch basin or area drain 18.76
�1 � . F - (t���l S
City /State /ZIP: '�� (( C -k Ce c aD I Drywell, leach line, or trench drain 18.76
- Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
>-1-- �L v
's Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _J Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) / Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backf10 v preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
��) tk..'t e 0 ,z (.-e Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER l El TENANT Expansion tank 12.51
/ i 1 Fixture /sewer cap 25.02
Name:
-- 1._;'e _V tom, i f r( 1ek'. 1 -Lrv\
�� p
Floor drain/floor sink/hub 25 02
Address: - -- p - (� c7Ji'Z D+ Garbage disposal 25 02
City /State /ZIP: -- 17 - C C v - G(f C �� a-DL) _ Hose bib 25.02
Phone: (a (7 Q _ \ S 3 Far: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical as value: $
Business name: g ( ) Page 2
'P�.1 �YV\ \n In o Primer 12.51
Contact name: i ' v aSe Roof drain (commercial) 12.51
Address: ? O . l am `-) Sink/basin/lavatory 25.02
City /State /ZIP: 'r'.1 ` f l.i -- a I (') t \Th2C Lt Solar units (potable water) 62.54
Phone: ( 3) a `D) _ ( , X.) - 1-J(Th Fax: : ( t(-1 ) a ii), , 8c u k Tub /shower /shower pan 12.51
E-mail: Urinal 25.02
CxI�G�C � � -CCam v6 �l0 An' ' `�� C C f C'1 Water closet 25.02
CONTRACTOR
?k fl heater 37.52
•
Business name: C C-t Y'C ?lA A lnn` rj1Y1 p, Water piping/DWV 56.29
Address: �. -� Other: 25.02
City/State /ZIP: 0
et ; - • Subtotal �9-�
one: (�j �� �_ (1)(\.2.:,(-1 Fax: (�) ��_� ��, Minimum permit fee. $72.50 -/p�
Plan review (25% of permit fee) r•
CCB Lic.: 1 L\ c .G1 Plumbing Lic. no.: Qt = -)) S• a
State surcharge (12% of permit fee) g.70
Authorized signature: ik c � '•-6, t TOTAL PERMIT FEE ( ,
Print name: i ' 0 i e 4- 0 0 /4• k f Date: /(� 2 /- ( ( This permit application expires if a permit is not obtained within 80 days
1 after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
t96uridinglPermits1PL MU.PermitAppdoe 10/01 /09 470.4616T(l0/02/COM/WPB)