Permit ` 1 y CITY OF TIGARD • PLUMBING PERMIT
11 1 _ COMMUNITY DEVELOPMENT Permit #: PLM2009-00130
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/29/2009
Parcel: 25111 DA00400
Jurisdiction: Tigard
Site address: 15435 SW HALL BLVD
Subdivision: Lot: 0
Project: Schmidt
Project Description: Install up to 100 feet of water service.
Owner: FEES
SCHMIDT ACRES LLC Quantity Description Date Amount
12525 NW JACKSON QUARRY RD
HILLSBORO, OR 97124 100 If Water Service 05/29/2009 $55.00
PHONE: 1 12% State Surcharge - 05/29/2009 $8.70
Plumbing
18 ea Minimum Fee Adjustment - 05/29/2009 $17.50
Plumbing
Contractor:
NORTHWEST CENTRAL PLUMBING CO INC
2870 SE 75TH AVE # 206
HILLSBORO, OR 97123 •
PHONE: 503 - 642 -2067
FAX:
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344. (�
Issued By: 1 ( 0 � . = , Permittee Signature: 1 I l^�, ^U
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.
05/28/2008 11:08 FAX Z 0 0 2 / 0 0 3
... , a e
Plumbing Permit Application
Building Fixtures
RECEIVED 11'011 OFFIC1•; US1; ONLY
...
Received
City of Tigard Permit No.:R ,. 06 k
--- 'I 13125 SW Hall Blvd., Tigard. OR 97223
Phone: 503.639.4171 Fax: 503.598.MV 2 9
I
2009 Dateffly:
Flan Review
Date/By; Other Permit No
Inspection Line: 503.639.4175
Tic:AA LI Dale Ready/By; lu a WI See Pup 2 for
Internet: www.tigard la • _ Notified/Method: 11 c Supplemental Information
. .
: : , : lil ' .,'W; ,:. , , ,,o 'r : lit.iiii:,l1 lil ,i l:'1' lil,:i I '', : I ;i■ ''" ,, :,,: ' _. '
LI New construction 1i1 Demolition For special information use checklist.
Desch • don • r ,, Ea Total
ir.■ • ddition./alteration/replacerrient 12 Other:
New 1- 2-family dwellings (includes 100 ft. for each utility connection)
e•lt ;001,g'SIiiiieiliON „,., , Il.',: . , , ;:'d SFR (1) bath 249.20
i'.! I and 2 dwelling 1:1 Commercial/industrial SFR (2) bath 350,00
D Accessory building 111 Multi-family SFR (3) bath 399.00
Each additional buth/kuchen 45.00
El Master builder 0 Other:
Fire sprinkler ( sq. ft.) Page 2
,! ,,,..;. '.;,.o ., ,..,.,,.,
43040, iA 'il PI blAll Site utilities
Job site address: . ;5 il .v — 1.... 1LA/D - Catch basin or area drain 16.60
City/State/ZIP: Cfp_.--FL amparmi Drywell, leach line, Or trench drain 16.60
Suite/bldg./apt. no.: Project name: Footing drain (no. linear ft.: )
Page 2
Manufactured home utilities 110.00
Cross street/directions to job site
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.; 1 Page 2
Water service (no. linear ft,: T icilY Page 2 55 cc
Subdivision! Lot no.; ,
Fixture or item
Tax map/parcel no.: .
1 li Absorption valve 16.60
' '' ''''''',' 'n' i itiFrifrePta I; OR ,;;1,'Hil(P11, !,;/ fi
' ) )0 ', ,'. IdfitiliataiiiiAtiti :! !, imf ' ii:;H'i; I.: ,'': , , N! iliiuiki,I -,.. Backflow preventer Page 2
01111P.ARIWAIl ; ' li= 111111 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
. Drinking fount 16,60
' . i 3O '.:VY OrOiN 1!;111HIlhii:'".L ain ;Ii.!L.:;',g117Pr
16.60
Name:
— _ Expansion tank 16,60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16,60
'' . ' 110 ipl*O ' '-' :1 : INN ;i''1111W'6i'liri4c11.,M1:40 ,, I-lose bib 16.60
16,60
Business name:
Intereeptodgmasc trap 16.60
Contact name; Medical gas (value: S ) pa; T
—
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16,60
Phone: ( ) Fax; ; ( ) —
Tub/shower/shower pan 16.60
E-mail:
' Urinal 16,60
i
. ' '' ...,;;.: .'; 4' "' , ., Hi■liVA !n "," ' ' , ,,, ,,. • ‘, .
;; ,d' , :i.: 1 , .. , ■;,j 1 , :‘ ,, ( , , , t-9 ,- .7, , „„ , !, ;,;; ,..„ „. , ,..,q ,,' ..,i,.',A,,,00, :,a, Water closet 16.60
Business name: N i .m tAj e .sT C f - A . 1 -„ 1/41., 7p rumelt4 Li C . Water heater — 16.60
Address: 1,s-1D sE, N . W -2.0c, Other:
Subtotal MEM
City/Statc,/ZIP: ,$‘301• i (2R-- I 91113
Minimum permit fee: $72.50
Phone: ( 50 5) • , •. 1,001 Fax: ( i 1 ) (IP 7... .5ci 5 Residential backflow minimum emit fee: 536.25 77.. _so
col Lie.: 1,7_ Plumbing Lie, no,: .- —1 .. 4 Plan review (25% of permit fec)
State surcharge (12% of permit fee) gam
Authorized signature: ik 6:501 Ai A
'
TOTAL PERMIT FEE I: L
W
EIMMI AIIMME Datcp 41 a This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
"'Fee methodology set by Tri-County Building Industry Service Board
11\ Eh \ Ixermilx \ PLMF-PerrnnApp.doc 12/27/06 440-61616T(10/02/COMMED)