Permit „ CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00307
Date Issued: 10/18/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S111AB08900
Jurisdiction: Tigard
Site address: 9395 SW VIEW TER
Project: Jordan Subdivision: PENROSE TERRACE Lot: 34
Project Description: Replace 50' of water service and repipe entire house, water pipe only.
Contractor: BOB'S REEDVILLE PLUMBING Owner: JORDAN, JO A
5976 SE ALEXANDER ST #C 9395 SW VIEW TERR
HILLSBORO, OR 97123 TIGARD, OR 97224
PHONE 503 - 356 -8832
PHONE: 503 - 639 -8171
FAX 503 - 356 -5245
FEES
Quantity Description Date Amount
50 If Water Service 10/18/2011 $62 54
Specifics: 1 ea Water Piping /DWV 10/18/2011 $56 29
1 12% State Surcharge - 10/18/2011 $14.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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 -0090 You may obtain a copy of the rules
or direct • - • to OUNC b ailing 503 232 1987 or 1 800 332 2344
Issued = Permittee Signature eaL 4
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.
Oct 14 2011 1:31PM HP LASERJET FAX p.
REC
PIumbing Permit Application OCT 14 2011 roe OFFICE USE, ONLY - .
City of Tigard Rxeived
_ a 13125 SW W Hall Blvd„ Tigard, DR 97 Dateley: f Q I f (( ' � -: ' Permit Ito
g OF TlrA; D Plan Review it U�'�ot! -QO 30
Phone: 503.639.4171 Fax: 503.59 .
t1c iAI �' ]? Inspection Line: 503.639.4I75 BUILDING DIVISION DalelBy:
Internet: www.tigard - or goV Date Ready/By Permit No.:
Y Duds: 81 See Page 2 for
Notified/Method: r ra, Supplemental Information
TYPE OF WORK FEE* SCHEDULE
^
[] New construction ❑ Demolition For special informrdon rise checklist
V Addition/alteration/replacement ❑ Other: Atsscri. • . Es. Total
New I -2- family dwellings (includes 100 fl. for each utility connectio
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
til 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath ' 399
-
Each additional bath/kitchen 45.00
❑ Mader builder ❑Other:
Fire sprin kler ( sq.IL) Paget
JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: 9 39' 5 5 v `e 0 1- 4.hAX-<-0--- Catch basin or area drain 16.60
City /State/ZIP: i'lQ1 1 c) ci 7 2:2_9 Drywell, Leach line, or trench drain ' 16.60
Suite/bldg. /apt. no.: Project name: .JO Jo r- 4Q CI
Footing drain (no. linear R.: _ ) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
e>� t q 3 rn Manholes 16.60
O `Oen lC1L9Lu Rain drain connector 11111 16.60
Sanitary sewer (no. linear R.: , Page 2
Storm sewer (no. linear ft.: ) Page 2 I, , „•
Subdivision: (Lot no.: Water service (no. linear ft.: CO ) Page 2 .
Tax map /parcel no.: Fi zture or item
DESCRIPTION OF WORK Absorption valve 16.60
� l� n J , 13aekflow preventer Page 2
(. 12 t -H' v . Backwater valve 16.60
I Clothes washer 16.60
Dishwasher 16.60
( P1tt?PEIt7 Y OWNER 1 ❑ TENANT Drinking fountain 16.60
Name: 0 J Qr C� 11
Ejectors/sump i 6.60
Address: Cr 395 S \I ) -j- Expansion tank 16.60
'-9_- Fixture/sewer cap 16.60
City /State/ZIP: tc3 s ,,,,Q
b " } ()2- D- 1 Z -Z'L1 Floor draiNfloor sink/hub 16.60
Phone: ( 10.3 ) C2,3 q_ Sr'l - 7 1 Fax: ( ) Garbage disposal
16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: $o b t S
Contact name:,. R�e(.r,.ut _ 1.0 / `L - C - Interceptor/grease trap 16.60
aN " r ..a.• a :►_.lia Medical gas (value: S ) Page 2
Address: SG} C� C
� G Ate 1t�R1) St Primer
City /State/ZIP: 1- }ti�1S/_,� -- Qt. p_, i 2.� 16.60
W I / Roof drain (commercial) 't L6.60
Phone: (Sp3 ) "35 ( $$ J Fax: : (g j ,- 4 _ sZ L . 5 Sink /basin /lavatory 1 6.60
E -mail: h�,, � ® a°el-Nr 4G nn -- Tub/shower /showerpan 16
td1Ufl ll COlYI Urinal
CONTRACTOR �o} 16.60
,� � Water closet 16.60
r
Business name: .-1Y1 , Water heater
16 60
Address: Other. ' t)f P f, 56.a14
City/State/ZIP: Subtotal _- ,- . a � p.�
, .-
Phone: ( )
Fax: ( )
Minimum permit fee: 572.50 �
Residential backflow minimum permit fee: S36.25 rig ■
CCB Lie.: / CO it Z3 3 ( 91;Aa_ Plumbing Lic. no.: .3 • 7 Pla review (25 %of permit fee )
` fi t'_ / l� pc
Authorized signature: �,.1��, l }e � , ' 7 / / '� State surcharge (12% of permit fee)- J
Print name: �" \+ TOTAL PERMIT FEE ' I 1 , -,
t+'�Pel26, Lc &-(., Date: o/ t 1 , i i 1 This permit application expires if a v
l p' permit is not obtained within
150 days after it has been accepted as eornplete.
*Fee methodology set by Tri-County Building industry Service Board.
4' / 53 ."