Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00119
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/15/2012
Parcel: 2S102CCO2500
Jurisdiction: Tigard
Site address: 13900 SW 102ND AVE
Project: Willard Subdivision: FRELEON HEIGHTS NO.2 Lot: 10
Project Description: Replace 42 ft. water service
Contractor: APOLLO DRAIN & ROOTER SERVICE Owner: NELSON, WILLARD & ALICE
2208 NW BIRDSDALE #8 TRUSTEES
GRESHAM, OR 97030 13900 SW 102ND
TIGARD, OR 97223
PHONE: 503-239-8801 PHONE: 503 - 639 -3502
FAX: 503 - 669 -9568
FEES
Quantity Description Date Amount
1 If Water Service 05/15/2012 $62.54
Specifics: 1 12% State Surcharge - 05/15/2012 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 05/15/2012 $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 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. /� I
Issued By: _ 1 ,t d Permittee Signature: i d 4 PP/ IC4 o&L
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.
May. 15. 2012 9:21AM Apollo Drain N� -103 P. 1 S/
1
Plumbing Permit Applicati4REC lVED
Site Utilities FOR OFFICE USE ONLY
City of Tigard MAY 1 5 2012 Received ,� / 17/ �C� oZ dt)(I
Date/By '/ Permi No. .
71 " 13125 SW Hall Blvd., Tigard, Olt 97
S u Phone: 503.718.2439 Fay: 503.5 OF TIGARD Plan Review
Dote/Ely Other Permit No.:
T 1 C A R n Inspection Line: 503.639.4175 bUILDING D! VIS!ON Date Read)/By. rurt • See Pope 2 for
Interact: www.tigard•or.gov Notified/Method: 'f14Q Supplemental Information
. :-.....:.:. is - " ` ' Ri ; fii4N i :_ '0 : j4 tilr ti ;l r _dk :
❑ New construction ❑ Demolition L`. t 1 � :; :Rt?s r ; 1' C ,TIX: : Q . "f �,Kks.:i ^- ..i
l\dditionlalterntion/replacement ❑ Other: For special in(ormada,: rise checklist
nt _ Description r Qty. r Ea. Total
? ".1.""' "'y '; w µr ' ; C1 TEG.Q :.t'.. „ l CO� ri . New 1- 2- Gamily dwellings (includes 100 R for each utility connection)
71,1- and 2- family dwelling ❑ Commercial industrial
SFR (l) bath 312.70
SFR (2) bath 437.78
❑ Accessory building ❑Multi - family SFR (3) bath 500.32 .
❑ Master builder • ❑ Other: Each additional bath/kitchen III 25.02
t r, ,; 3 =.: ( 4,S 1~ OR,,,,. Y- FL;AgIDZ :OCi .,,. !.- , fir, , _ Fire sprinkler ( _ sq. ft.) Page 2
Job site address: T Site utilities:
I ' ��' , ���/� ���� Catch basin or area drain 18.76
City /State ZI?: t g
,�r � �Ke Drywall, leach line, or trench drain 18.76
Suite/bldg./apt. Footing drain (no. linear ft.: _) Page 2
C Manufactured home utilities 50.03 '
• Manholes' 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: Page 2
Subdivision: • Lot no.: Water service (no. linear ft.: Page 2
Tax map /parcel no.: Fixture or item:
- -,r_ xt f '�� y �.�.� a^ :3� Backflow premier 31.27
i -. , -.crir.. - -,n., _ uara P: e ..p _ _
, 4 _<, r Old F�WU 7 ^.
5�:;� ;,.._.... _ - �.rs�?.z >1., - Backwater valve 12.51 -
Clothes washer 25.02
P.Q)1(LCQ - 42i-two j ilLL . Dishwasher 25.02
Drinking fountain 25.02
, _ I _ - .. T ,,..:� + r -wAisy . �� tiii Ejector is/sump 25.02
r -�RI'Y�¢�'�?ti:•� rr �% ' �E�E1�AN �'
Name: IIM �/ t , ,1� I, f1 Expansion tank 12.51 •
Fixture/sewer cap 25.02
Address: t1 Il ' g�1�� Floor drain/floor sink/hub 25.02
City /State/ZIP: graniffiltilMMIMIIIIIIIM Garbage disposal • 25.02
Phone: a l ' s ��i� - I1M Fax: ( ) Hose bib 25.02
: a l9 9 _x'. 0 . -. �1PP 1 s �I.A i• 4 rr4.•'?`; ❑v�ZO I' r• aRS'b ,>i,,,._: Ice maker 1251
Business name: V r ■ 1 Interceptor /grease trap 25.02
a�.�V if . •• \ II • ) Medical as value; Pa e2
~ohtact:name :- Al a& & i !7a�a► _ ® - _
-
r Primer' - -- • ' ,
Address: a � � � ■ 1 �r P!�1%�� ��\
a gif�
Roof drain (commercial) 12.51
City/State/ZIP: Alfa Mg ifra inliMall Sink/basin/lavatory 111111 25.02
Phone: M" 1 p J4 � _ (� / `� i Solar units (potable water) 62.54
. , r ►, l1 `, J , rff . I , 111b /shower / shower pan 12.51
E -mail; I /�t�A]] f1 /� 1[e�
�-. Urinal 25.02
...i:ti7{ i 9 :% ". .r K-,ri 1. � .i�',4' 1N. �;!" I 25.02
`�;r •-;:. ��::��:• �c:t<;;:,, >:'�� •.� Q.� �> �..�• ,., L'�,.�..''. ,. -r.•e }r, -: =. Water closet
Business name: AA / • • 1 i \ , 1 lt! _J Water heater 37.52
Address: r� W piping/DWV 56.29 W
l��r � y
City/State/ZIP: Wardivareinini� Other: 25.02
Y ��
Phone: 45l(j .4212s�ll /yam Fax: A l . I (0. Subtotal
. 'M I1 VAITAQINI Plumbin g Lie. no.: gb ■ 1 Minimum permit fee: 572.50 44,5`F
Plan review (25% of pcnnit fee) 1_ Q6
Authorized signature: r� � / ,� State surcharge (12% of permit fcc) $', '� V
Print name: ��' . � ` �Dat mum TOTAL PERMIT FEE I ?(. /
t: Building■Permit WLMU -Pe nth pp.doa 10/01101 440 -4616T(I0r02 /COM/wES)