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Permit
CITY OF TIGARD PLUMBING PERMIT . COMMUNITY DEVELOPMENT Permit #: PLM2011 -00369 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/08/2011 Parcel: 2S112CA05400 Jurisdiction: Tigard Site address: 15381 SW THURSTON LN Project: Marcot Subdivision: ASHFORD OAKS Lot: 8 Project Description: Replacement of less than 50' of water service. Contractor: PIPELINE PLUMBING Owner: MARCOT, BRUCE G AND 333 S STATE ST, STE. V -108 SAKAI, CARRIE S LAKE OSWEGO, OR 97034 15381 SW THURSTON LANE TIGARD, OR 97224 PHONE: 503 - 624 -1906 PHONE: FAX: 503 - 624 -1926 FEES Quantity Description Date Amount 50 If Water Service 12/08/2011 $62.54 Specifics: 1 12% State Surcharge - 12/08/2011 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment - 12/08/2011 $9.96 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 Not =_ • • er. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dire questions to OU C b . ing 503.232.1987 or 1.800.332.2344. Issue. :y: / /- Permittee Signature: O !. 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. Jul 09 00 03:28a p.1 �P iumbing Permit Anpl icatio �� RECEIVED Building Fixtures i >�11, O l li t: 1. ` : 011,1 II City of Tigard o L c 8 20» 0 / ,, k • , 1tmiitNa: in dezi -r o .7 13125 SW Hall Blvd., Tigard, OR 97223 2 : ` Phone: 503.639.4171 Far 503598`1�6i0y OF TIGARD PIanItevicw olberPerai:ldo.: i Ic;,..,R � .s . ov BUILDING DIVISION l �sr /� se see zr� NoGtiaUMcthod: � S pp sal informa TYPE OF WORK FEE* SCHEDULE ❑ New construction Q Demo .; on Forsp®r3at Information ucetkthe Description 1 Qty. [ Ea - I Total K Additionlaiterationhepiacement Q Other. New 1- 2- family dwellings (=hides 100 Ii. fir car' utility comte ) CATEGORY OF CONSTRUCT? D N SFR (1) bath 312.70 • 1- and 2- familly dwelling ❑ Canmiercial mdushial SFR (2) bath 437.78 SFR (3) bath 50032 © Accessory building Q Multi- y - 0 builder 0 Other: Each additional bath /kitchen - 25.02 Fre sprinkler (______ sq. $) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: lob site address: i 1 5 - 6q t� I r l c� l Catch basin or area drain 18_76 City/State /LIP: ` j� 1 V 2:2_ � ti, leach line, or ter drain 18.76 1 (� , l Footing drain (no. linear it: ) Page 2 Suite/bldg/apt. no.. Project name: Ad • Mangy home utilities 50.03 Cross street/directions to job site: Manholes 18.76 'it-/ / , C Rain ry sewer (no. l inear 1 ge2 - 8.76 e i Sanitary wer (no- linear IL: ) Page t r Storm sewer (no. linear it: ____) Page 2 Water service (no. linear ft.: 5V ) ' Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Batltflow prevent= 31.27 i DESCRIPTION OF WORK Backwater valve 12.51 t Clothes washer 25.02 • /. .- :_'.A' ‘' . . Ill l to --. � Dishwasher 25.02 • ` l C Drinking fountain 25.112 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑TENANT Expansion tank 12.51 Name: Fixturasewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 Garbage disposal , City /State/ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ ONTACT PERSON In�ad trap 25.02 Business name: Pi. 1� l ;Y�Q� t l A IN j . 1d`■_9 Medical gas (value: S ) Page 2 Contact name: �"-� I Prim 12.51 Address: • Roof drain (commercial) Sink/basin/lavatory 25.02 City/State/ZIP: Solar units (potable water) 62.54 Phone: ( ) Fars:: ( Tub/shower/shower pan 12.51 • Urinal 25.02 E f► i / a •` Z :t • 0 \: - CONTRACT(' .� - ' 1 - 1. war= closet 25.02 d I Water heater 37.52 Business name:. i' p i\ ._ t rx r Water piping/D W V 56.29 Address :3 �L ± li r C3 ti Other: 25.02 City!State/Z1P: s '' _ Q e_•0 ilt. cit. Subtotal Phone: ( (s) . x4 � CC 011 Fa ( r, Lo 2 i L t 61 2 � Minimum permit fee_ 572.50 72 .c CCB Lie.: I S j 6- () Plumbing - c. no.: , • Plan review (25% of permit flee) ,---- . State surcharge (1254 of permit fee) g.7D Authorized sigrhat ♦ TOTAL PERMIT FEE AO Print ramie: y, A ,, ,: 49 � & a �- r 30 , D ate: . ' r 1 a P t pf cation eiplrea if s permit ie not ab4riaed within l8 AtIL { I • alb it has been aid as complete * Fw... orhroi.Jnuv..f1..,Trl.r....ww.A 1.1:.... i..,1...+... C...,;,.,. n....i