Permit la
CITY OF TIGARD PLUMBING PERMIT
s ,
COMMUNITY DEVELOPMENT Permit #: PLM2009-00233
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2009
Parcel: 2S112BB11100
Jurisdiction: Tigard
Site address: 14258 SW FANNO CREEK LP
Subdivision: Lot: 0
Project: Hookie
Project Description: Replace 60' of water service.
Owner: FEES
HOOKIE, ANN Quantity Description Date Amount
14258 SW FANNO CREEK LOOP
TIGARD, OR 97224 60 If Water Service 08/25/2009 $55.00
PHONE: 503 - 684 - 1852 1 12% State Surcharge - 08/25/2009 $8.70
Plumbing
18 ea Minimum Fee Adjustment - 08/25/2009 $17.50
Contractor: Plumbing
CASEY'S PLUMBING
P.O. BOX 30075
PORTLAND, OR 97294
PHONE: 503 - 253 -0030
FAX: 503 - 262 -8251
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 quest' . OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B : / /41, Permittee Signature:
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.
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^ Aug 24 09 11:02a Case's Plumbing 5032628251 p.1
Plumbing Permit Applicatian� •
Building Fixtures , l� , FOR OFFICE USE .ONLY
City of Tigard R ,� G t9��l�0�3
'B. Permit No )
Mi
13125 SW Hall Blvd., Tigard, OR 97223 AUG
DateBy: o1s o .��r
Phone: 503.639.4171 Fax 503593 ,I- -960. Plan Review Other Permit No,:
t.,l 1 V OF i IGABD DaleBy:
Inspection Line: 503.639.4175 \ DSUe Ready/By: Juris: ® See Page: for
-T[GARD Internet: vwww.tigard- or.gov PL�iNN,NG�E" tai EEF� N' i ti tfied/Method: li t- Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
: X/ /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
I CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. fl.) Pace 2
JOB SITE INFORMATION AND LOCATION Site utilities _
Job site address: ' ���� � V-Cvlrv CAL ctroc Catch basin or area drain 1 6.60
City /State /ZIP: C CV` A �, ! � Q Q 4 , Drywell, leach Tine, or trench drain �_ 16.60
Fooling drain (no. linear ft.: ) T Page 2
Suite/bldg. /apt. no.: Project name: i
Manufactured borne utilities 110.00
Cross street/directions to job site:
Manholes 16.60
N..0-c1 l�Cs-.Q�c_ C•c5 1 �C Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.:.L ) i 1'age 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Cc- ` -
...( \,t c e ( c l /� . i - 1 Backwater valve 16.60
Clothes washer 16.60
- Dishwasher 16.60
OPERTY OWNER O TENANT Dnnking fountain 16 60
Ejectors/sump 16.60
Name: `\ - �Oti....-tt... Expansion tank 16.60
Address: ;/.J ef S FG- t\VA.() C A/ �Q C, t o Fixture /sewer cap 16.60
City /State /ZIP: ---' t,�.f. cP CA ��4 Floor drain /foorsink/hub 16.60
� I c
Phone: (x,i3) 6. A;..1 1,5.D Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
0 a„'Pr IIC.ANT 0 CONTACT PERSON -------------
Ice maker 16.60
i Business name: C.e S ' if`Ctb C Interceptor /grease trap 16.60
Contact name:``, ` Medical gas (value: $ ) Page 2
Address: '-c) , ' X �"�� Primer 16.60
City /State /ZIP: ',-{ i t l O a o `_ 2c,04 Roof drain (commercial) 16.60
Fax: : Q } 1 ` Sink/basin /lavatory 16.60
Phone: (-
(t-3) a u i a - ", ` Tub /shower /shower pan 16.60
E Crjr1- 1 ro..0 C -.e-e -Se --, 9 j - Wr\ a Urinal 16.60
l
CONTRACTOR Water closet 16.60
Business name: _ S J YA1OL . Water heater 16.60
Address: `7, V r Ci `"Wj}C 3C%C5Y 5 Other:
City /State /ZIP: ?0(4 . s �- c--4
Subtotal
Minimum permit fee: $72.50
�� •� �
Phone: (S---63 ) , 53 - Cad Fax: (S) a uo_ ..mil I/ Residential backtlow minimum permit fee: $36.25
CCB Lie.: 14--u ,/ Plumbing Lie. no.: -- 12,5 Plan review (25% of permit fee)
Authorized si rats State surcharge (12% of permit fee) . 70
g c�CltiC � � / TOTAL PERMIT FEE ki, ,A0
Print name: fACLol- . lie d +fc.� Date: 5/24 /v This permit application expires if a permit ted is not obtaine Q d within
f 180 days after it bas been a ccep as co mplete . a/ f
*Fee methodology set by Tri- County Building Industry Service Bo r v.
t:\ Building 'Permits \PLMP- PermieApp.doe 1 2/27 /G 440.4 616T(70/02/COM)\VES)