Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00354
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/29/2011
Parcel: 2S112BA04600
Jurisdiction: Tigard
Site address: 14295 SW 80TH PL
Project: Weaver Subdivision: WAVERLY MEADOWS Lot: 9
Project Description: 100 ft. of water service.
Contractor: PIPELINE PLUMBING Owner: KROPP, BEVERLY & WEAVER, RIC
333 S STATE ST, STE. V -108 14295 SW 80TH PL
LAKE OSWEGO, OR 97034 TIGARD, OR 97224
PHONE: 503 - 624 -1906 PHONE:
FAX: 503 - 624 -1926
FEES
Quantity Description Date Amount
100 If Water Service 11/29/2011 $62.54
Specifics: 1 12% State Surcharge - 11/29/2011 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 11/29/2011 $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. 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ittee Signature: to
Call 503. • •. 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.
Jun 29 00 03:23a ,-.).1 RECEIVED
P lumbing Permit Application •
Building Fixtures NOV 2 8 20 I:(;>IR OFl lc l SE (Nl.N
City of Tigard CITY OF TIGA ' , : ii: .>.�► l No.: Y
ip 13125 SW Hall Blvd OR 97223 , Tigard, -''• •
Phone: 503.639A171 Fax 503_598.1960BUILDING D1VI pehorPc nit i
I la S
lisp Line:503.639A175 IJMeRemdY/BY Information :: ;'. : � Internet www tigard- or.;av NotiS lIMe 1 l'
TYPE. OF WORK. VEE* SCHEDULE
• For specialWarn:adott use eheellitst
❑New naron ❑]Demolition a.. Ea. Total
7 Addition/alteration/replacement ❑ Other New I- 2- family dwellings (includes 100 it for each utility )
CATEGORY OF CONSTRUCTION SFR ( bath IIII 312.70
SFR (2) bath 437.78
141- 2-family dwelling ❑ SFR (3) bath 50032
❑ Accessory building ❑ Multi- Each additional 25.02
❑ Master builder ❑ Other Eire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
(� r� Catch basin or area drain MI 18.76 MIN
/ Job site addres l 2 - 1 C � 5 )k) 7 ?0t" p Ihywetl, leads line, or trench drain 18.
City/State/la': 1 1 C ,, 1 r C( 2 Footing drain (no. linear ft.: _,a Page 2
� Suite/bldg./apt. no.: j .1 tee: �e ., At Manufactured borne utilities 50.03 Ill
vJ directions to job site Manholes 18 76
Cross street/ J
• e Rain drain connector 18.76
is Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (eto. linear f.: ) } Paget k , ,'lc
3 S ubdivision: I Lot no.: Mxlure or item:
Becidlow preveoter 31.27
%el Taxmap /parcel no.: Backwater vahre 1251
D ESCRIP TIO N OF WORK Clothes washes 2 . 5 - 0
;10 \ a _ i t *ELI 1 - A Dishwasher 25.02 ill
�In G Dr inki n g fountain 25 Ejectors/sump MI 25•0
❑ PROPERTY OWNER [ ❑ TENANT won tank ® �
Fixture/sewer cap IIIII 25.02
J Floor chain/Boor sinkAncb 25.02
Adam dr
Address: Gasbage cEsposal 25.02
City/State/LIP: Hose this 25.02 Ell
"'hare: ( ) Fax ( )
lee maker 12.51
.....:g ❑ APPLICANT ❑ CONTACT PERSON fit; trap Medical gas (value: S ) 2102 MEI
Business mine: p, ,i \ vim_. li'vk S O Al Med 12.51 IIM
Contact name: Roof drain (commercial) 12.51
Address: Siak/basin/lavaten)' 25.02
Solar units (potable water) 62.54
City/State/ZIP:
( ) Fax: ( ) Tub/shower/shower r /shower pan 1251
.' Phone:
25.02
E-mail 1 4 1! t �
t ,1 eat `_ Il Urinal MI 25.02
deft CON - 'Water heater 37.52
13usiness name: A • %''' . A a t . Water piping/OW 5639
. ,i 0 Other • 25.02
Address:`3 �_.� '' a1lw 41
City/StatelZIP: ' ! (
r 0 , ice, ' ( O( 1 (33 Subtotal
Phone: ( 53 �? 2—q k `tp L-f Fax: (15 .) tt9 2-Lk l G1 r 4 Dffiaimum permit fee: $72.50 =1
!��. Plan review (25% of permit fee)
CCB
Lie.: : ` j"� Plumbing Lie. no.: 3 i D -e State sv (12% of per fee)
Aulhaized signature f , r TOTAL PERMIT FEE !Tim �L.y � __L lt!1 _AA .V � TVs @emit mpplicailea . empires Ira per>ait is not obtained wt,, ., : i days
lint _ 1 - � ►f l lei Date: t l �4'�,�] * 5.a .,,o l.�,,ni.r..,awl �:.�- complete.
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