Permit CITY OF TIGARD PLUMBING PERMIT
1111 2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00379
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2011
Parcel: 1 S136AD06800
Jurisdiction: Tigard
Site address: 7001 SW PINE ST
Project: BRIDGES Subdivision: 1992 - 059 PARTITION PLAT Lot: 1
Project Description: Toilet installation.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: BRIDGES, JON P
P.O. BOX 2830 13065 SW FALCON RUE DR
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 235 -8784 PHONE:
FAX: 503 - 491 -2932
FEES
Quantity Description Date Amount
1 ea Water Closet 12/21/2011 $25.02
Specifics: 1 12% State Surcharge - 12/21/2011 $8.70
Plumbing
Type of Use: SF 47 ea Minimum Fee Adjustment - 12/21/2011 $47.48
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 ' Permittee Signature:
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.
DEC 21 2011(WED) 12:42 ARS /JackHouk /RescueRooter (FAX)503 491 2932 P.001 /002
Plumbing Permit Appli .)4C)
Building Fixtures
City OR OF ICE U SE O
�f Tigard ty I � ,0 Received
a 13125 SW Hall Blvd., Tigard, t .3 17ate(By: D' ,I Zr / ',; 571"'"614 P ))1a+- , 7C;
Phone; 503.63�J 4171 Fax 5(1 r36O - 9 �49Q� D1nn Review
1'1CARD Inspcctiull Line; 503.639.4175 , �‘� `S D
IN
1 u:uarBy: jjy .. ....
Internet. WwW hgard pr,goy ' -� ate Ready /By: mrls: RI 5,
o Notiiied /Method:
Irr`iiil,l. , 1}l,rItF4.L�ii1 /IL�kY, I j .• tl 8 'x� l
Y?4 tit l("' 1 4 •
! 1➢ l 1� ' �� W !� K1'� l wl:i�i SYYDG._. 1 pl
�'. � . � 1� 1i. „ 1,!
k a ..54„111 i r� l ' i � ' , / ,71YFA, 4ik ` �, �({ • E�9,Yy111� {pYl ,t ,, p 2 A � ! 4 4 ' ,'4. —
�{I 1�li��I� 1����� tl,� .IVYIIY'�i �' L 1 1, 'M M .. A Y. t
New constniction C] D, 4 ion For special in ormntion use checklist. _
V,./ Addiltiln /ultCliitlott /re Inccntent Description Qry, L•u. 1 Total
P Crf Oth New 1- 2 -famil dwellings o ft. for each utility connection)
��';�� °11�t�i`�1� 1+yF {� ��� of ., t � utnu� n i s r I i,; Y (includes 100 s,• ('
, ax,r { tSd , .v riYkm�. t a ;df:a srr�' c+!�;' 't ) I �� I,9, lli} d f ' FR (1) bath M 312.70
Mill
l - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath
❑ Accessory building 0 Multi - family 112 500,32
Each additional bath /kitchen Lil 2 5-02
❑ Master builder 0 Other
I ' ' ` i r L � t t r site site utilities:
i
, ( sq, R.) Page 2
i
I
Job site „
i ;7t ;,Y t 9 � 1 , it r � G��ti tl , , ��,Y�� 1 � " I , ra t tj��� ti utilticv:
,4 "6� +te e) r a � � 9 1 , Rtt. � .. t� �9 " ik � I;YiM..t
/ Catch basin ur area drain 18.76 ,
City /State/ZIP: /V / Drywell, leach line, or trench drain 18.76
Panting drain (no, linear ft.: _) Page 2 El
Suitc/bldgJapL nu.: Project name: r $
Manufactured home utilities Mil 50.03
Cross sIrCCt/directiuns to job site: _ Munhglps M 18.76
Rain drain connector 8
ge2 ' I
J
_
• Storm sewer (no. linear ft.: _ ) �iL��t�� �x'7
Water service (no. linear 0.: ) -66”
Subdivision: Lot no.: Fixture or Item: WA
Tax ma /parcel no.: I3ackllow ptevcntcr 31.27
dl #'Yi), , ;'khtltHYl '. z'M l o ti a a "il a i lAt •t° Y ' ( t � ;t ,i (tl ;,. y1 l ,:;j� �!'i„ Backwater valve
� A h, a! I it V3 1�:, Ir ,ati)�Y ���4 i �� � {.6. t 1'1.51
�1S` 1, / . ,4 rte. Ol?� zs.o2 MI
1,70"` T �" Dishwasher 25 -02
4 • , IN Drinking fountain 4 � ' . _' ',r I
mil r.,,,, Ejectors/sump �� ��iittlG�.��
14`t4tt y Itl 1., , " I Yat 7 'I u, I a`.I,r'trF t . , t. c u r t^Inu l dr
�a� . mr, , , r t , �, 1 `l.1 Y � 1 I � �R� 1rl,'� �1 1 l 'i b4a kxpansiou tank r , ra.0�2 � i �
1 41 .v-
Name; ' ' P,Z / Fixture/sewer cap VIM 25 -02
Address: Ad, , M V60 Floor dniln/floor sink/hub 25.02
City /State /ZIP: // Zr-7.2-- m
Garbage disposal 25 -02
]lose bib
Phone: ( 11Ir A W E ) lee maker 22.51 I= P• � , 1 ' t , l , h ! , tN ,.'(1 = � M ` S T ti y1 '�r�it! �YKl4' ,, C�L (q µ l ) r�' lntcrce h)r/ �rcAs tra 12.5 J M taEMEEZ Ma�s9lM � 51 ' 3 r�lE O rrtl ct � �iNt � `(� p b r) 25 -02
MM.
Business name: ARS dba JACK k1OWIURF,SCUE ROOTER Medical gas (value: $ )
Contact name: JOYCE DENNIS 12.51
— . —
- Address: P.O. BOX 2830 hoof drain (commercial) 12.54 •
— Sink/basin /lavatory 25,02 Mil
City / State/ZIP: C1.ACKAMAS, OR 97015 _ Solar units (potable water) 62.54
Phone: (503) 850-3100 Fax: : (503) 491 -2932 Tub/shower/shower pun ,
E-mail: .IDENN1S &ARS,COM Urinal 25.02
I + �t ,t,,, A : Slli ' J i ,� d am' ls " i °" t j Y l�l " ti p r i, wtl 116 En 25.02 rill
2
' S i ^{ � ,( W ate r closet
� � 1 ��' � � � w (� 1 1rt ��, , � L , w. � . S{! � �Lk��C 'tl,Y�J�t! "u ���i1, 61tSi�1w1 „1�f,wR:'.�du�Inxl,
Business name; ARS dba JACK HOWK/RESCUE ROOTER Wa le nccater t
Water piping/DWV/ M 5629
Address: P.O. ROX 2830
Other; 25.02
City / State/ZIP: CLACKAMAS, OR 97015 Subtotal
Phone: (503) 850 -3100 ���
Fax: (503) 491 -2932 Minimum permit fee; $72.50
CCB Lie.: 127325 1'lurnbin • ic. no.: 34-168P13 Plan review (25% of permit fee)
Authorized signature: • State surcharge (12% of permit fee) MIN
-
I ^ Print name: J OYCE DENNIS Date: '1 hiy pe rmit a pp l i ca t ion exp i a permit Is not obtain ..25118Mr,
liner it has been accented as comtdete. „ qt
�(,/� � .Fee methodology set by Tri- County Building lndush Service he;xrd. f5 Q't
LlBuitdinitlpr ,„nilaLMIr- Prrml,Apptl IU '” 44 'o M / e 1:l4) �'4