Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00246
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/03/2009
Parcel: 2S 104C D00300
Jurisdiction: Tigard
Site address: 13559 SW HILLSHIRE DR
Subdivision: Lot: 0
Project: Wargo
Project Description: Replace 50' of water service.
Owner: FEES
WARGO, RICHARD Quantity Description Date Amount
13559 SW HILLSHIRE DR
TIGARD, OR 97223 50 If Water Service 09/03/2009 $55.00
PHONE: 503 - 709 2926 1 12% State Surcharge - 09/03/2009 $8.70
Plumbing
18 ea Minimum Fee Adjustment - 09/03/2009 $17.50
Contractor: Plumbing
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503 - 239 -8801
FAX: 503 - 669 -9568
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: ` „/ • Permittee Signature: i ' /V e/ - p
/ u 64-77 d
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.
�' -- 1 Sep. 1. 2009 1:01PM No. 3932 P. 1
Plumbing Permit Applicatin t, % .
. Building Fixtures i�l , "�r ti--4 . Irolc OFFICE USE ti■I Y
City of Tigard S E P 0 1 2009 Received J � l
Date/By: v Pemi" No -'P egi OQ aegr
III
n 13125 SW Halt Blvd., Tigard, OR 97223 y- '��� / P
Phone. 503,639,4171 Fax: 503.59 60 D
Plan to /B y; Role OtherP rmitNo,;
�t ( O r T IGARD Date/Il _
TIGARE1 Inspection Line: 503.639.4175 ON D ate R ea d /B : E1 s ee Pa c 2 f or
. Internet: wttw.tigard•or.gov BUILDING DIVISION Notified/Method: M Supplemental Information
TYPE OF WORT( FEE ", SCHEDULE.' .
❑ New construction ❑ Demolition For special Wornradon use checklist.
- Description I 91y- I Ea, I Total
Addition/altcration/rcplacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY., OF CONSTRUCTION .. : . , • , . SFR (1) bath 249.20 •
F.2 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
I=1 Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( , sq. ft.) Page 2
' JOTI SITE, ]NFOR MA TION'AND OCA ON
TI.:, - -
Site utilities
Job site address: 0 . _ . ) Dq n1 -L 1 , _ ■ - Catch basin or area drain 16,60
A. City /State /ZIP: ' c -11, v( 06e, 9 - 2--2- I3rywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 ' t Project name: footing drain (no. linear ft.: �) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: rn Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no, linear ft.: ) Page 2
Subdivision: Lot no.: Wafer service (no. linear ft" :Q) ! Page 2
• Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRI3?TION - OF \ -`
y ` � . - . Page 2 • r� ` I / ill / : ~ 1 o Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
r .. R Drinking fountain 16,60
..: r: .. OP RTY OWNER .: 0. TENANT... •
Ejectors /sump 16,60
Name: .11211111110101:111 Expansion tank 16.60
Address: 4 Fixture/sewer cap 16.60
V
City /Stale /ZIP: Floor drain/floor sink/hub 16.60 �~
Phone: ( 6) 109 , 7_ Z-La Fax: ( ) Garbage disposal 16.60
l . D APPLICANT • ..:
.'.,.:...r _:: El CONTACT. PERSRS ose bib ON
Ice maker 16.60
Business name: Interceptor /grease trap 16,60
Contact name: Medical gas (value: S _) Page 2
w
Address: Primer 16.60
City /Slate /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
•
- CONTRACTOR .
Water closet 16.60
Business name ' .6 I .J /. I.. I � r - r , - Water heeler - 16.60 411 z2 Address: G � r ► / ix , , I Other: - .`
Subtotal
a.1.4 /ft I A A Minimum permit fee: $72.50
Phone: (,, I j y , i _ 2
Residential backflow minimum Kermit fee: 536.25
1
� r .50
CCB Lie,: 1 /94/ 1 , ' Plumbing Lb .no.: � I� Plan review (25% of permit fee)
iik State surcharge (12% of permit fee) d , 7D
Authorized si nature: / (� '7 i `l
g 1 44 • _ et -, 0 c- e TOTAL, PERMIT FEE ? i , A. a
Print name J Date: 4 0. N/ This permit application expires if a permit is not obtained within
-Imp- Igo days after it has been accepted as complete.
'Fee methodology set by Tri•County Building Industry Service Board.
r\ auildins \POrmitu\PLMFPe+MLApp,dec 12/47/06 440- 4616T(l0 /02/COMAVEE)