Permit CITY OF TIGARD PLUMBING PERMIT
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I COMMUNITY DEVELOPMENT Permit #: PLM2012 -00202
T R; A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/24/2012
Parcel: 25111 CA14500
Jurisdiction: Tigard
Site address: 9825 SW SATTLER ST
Project: Starkey Subdivision: ALDERBROOK FARM Lot: 8
Project Description: (1) backflow preventer
Contractor: AMERICAN PLUMBING SERVICES INC Owner: STARKEY, WILLIAM L & BONNIE K
5905 N INTERSTATE AVE 9825 SW SATTLER ST
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE: 503 - 289 -6498 PHONE: 503-620-7646
FAX: 503 - 247 -2429
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/24/2012 $31.27
Specifics: 1 12% State Surcharge 07/24/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 07/24/2012 $41.23
Plumbing
Class of Work: OTR
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 By: /I a , , 1 _ _ _ Permittee Signature:
y/j/(/J �/ C ( al ll l 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 23 12 12:15p American Plumbing Service 503 - 247 -2429 p.1
Plumbing Permit ApplicatioEIVED
Site Utilities
Review
City ofT� Tigard
JUL 2 3 2012 Received ?.. I 1 ?Cncl - DAt ti.
114 `J e
g l Permit No
13125 S W d., Ti 1hteBy. 4
C Y gard, OR 59 Plan Re
Ph one : 503 . 718 Blv . 2439 Fax: 503.5 Vd 11IGARD Da Plan Re Other Pmnil No.:
7 1 G A R O
Inspection Line: 503.639 BUILDING DIVISIOND° RReady/By. 1 pi F I S et Page 2 for
Internet or.
eC wvrw.ligardgov Notified/Method:
V� Supplemental (t don
I
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 0tv. 1 Ea. 1 Total
® Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SIR (1) bath 312.70
® I -and 2- family dwelling ❑ Commercial industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 50032
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site entities:
Job site address: 9825 SW Sattler St Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State-21P: Tigard, OR 97224 Footing drain (no. linear ft.: ) Pic 2
Suilc/bldgJapt. no.: Project name: Bill Starkey Manufactured home utilities 50.03
Cross strcet/directions to job site: Manholes 18.76 .
Rain drain connector 18.76 j
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear R: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: BackOmw pseveMCr I 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Backflow Valve Installation
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER i ❑ TENANT Expansion tank 12.51
Name: Bill Starkey Fix[urtisewer cap 25.02
Address: 9825 SW Battler St
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /State/ZIP: Tigard, OR 97224
Hose bib 25.02
Phone: (503)620.7646 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: American Plumbing Services LP Medical gas (value: S _ ) Page 2
Contact name: Tony Johnston
Primer 12.51
Roof drain (commercial) 12.51
Address: 5905 N Interstate Ave
Sink/basin/lavatory 25.02
City/State/ZIP: Portland, OR 97217 Solar units (potable water) 62.54
Phone: (503) 289 -6498 I Fax: : (503) 247 -2429 Tub/shower/shower pan 12.51
E -mail: plumbinggapaIp.eom Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: American Plumbing Services LP Water piping/DWV 56.29
Address: 5905 N Interstate Ave Other: I 25.02
City /State/ZIP: Portland, OR 97217 Subtotal 31.27
Phone: (503) 289 -6498 t� Fax: (503) 247 -2429 Minimum permit fee $72.50 72.50
B Lie.: 151062 (, j t k (("' - PJ Ibin Lic. no.: 26 -567P6 Plan review (25%of permit Ex)
C,C
Authorized signature: / 'L`l�l� State surcharge (12% of permit fee) 8.7
TOTAL PERMIT FEE 99.32
---ww This permit application expires if a permit is not obtained within 180 days
i
Print name: Kyle Harms i ate: 7/23/12 15 (. ap s f
after it has been accepted as complete. complete. •Fee methodology set by Tri- County Building Industry Service Board. O
I: I3,otdire \PermhSPL.61t1•PermitApp,doc ItemA9 440-4616T(1a1
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Date: 7 /23/12
Please FAX this completed and signed form to 503.598.1960.
• DO NOT EMAIL THIS FORM a :
For your protection, this form will be destroyed after your payment has been processed.
I: \ Building \Fomn \PaymencAuhriization_03: S l2.dcc
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