Permit n CITY OF TIGARD PLUMBING PERMIT
`' COMMUNITY DEVELOPMENT Permit #: PLM2012 00253
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 2S102BD01001
Jurisdiction: Tigard
Site address: 9975 SW WALNUT ST
Project: Walnut Creek Apts Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 7
Project Description: Replace water service to 9945 SW Walnut and 9975 SW Walnut
Contractor: PORTLAND PLUMBING CO Owner: BLINE, RONALD G &
16470 SW SWAN AVE SAGUN, JUDITH L
OREGON CITY, OR 97045 2190 SKYLINE DR
SEASIDE, OR 97138
PHONE: 503 - 723 -8800 PHONE:
FAX: 503 - 723 -8801
FEES
Quantity Description Date Amount
300 If Water Service 09/04/2012 $137.58
Specifics: 1 12% State Surcharge - 09/04/2012 $16.51
Plumbing
Type of Use: MF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $154.09
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of .R. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if •.rk is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to folio' = - - .o.ted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain • copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: A / Permittee Signature: S
vim. i '..4 11. daMP
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.
Plumbing Permit ApplicationRECEIV ;-
Site Utilities FOR OFFICE USE ONLY
SEP 0 4 2012 R eceived
City of Ti and Permit No
14 11
131 SW Hall Blvd., Tigard, OR 9722 1 ► OF TIG R® Date/By: q � (Y}� A�7O�a- '(�Qp1
P hone: 5037182439 Fax: 50359 TIGARD
Plan Review
7 . . .
. `' Other Permit No.:
ry WG DIVISION
DateBy
Inspection Line: 503.639.4175 p.. LJ °J(QJO Date Read /B Ju ris: ® See P e 2 for
TIGARD Ready /By: g
Internet: www.tigard- or.gov Notified/Method: r i (D Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Z Addition/alteration /replacement ❑ Other: _ New 1-2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ® Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 9975 SW Walnut Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard Or
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name:(odL1J1T dec.( 4,73. Manufactured home utilities 50.03
Cross street/directions to job site: 1/2 blk north of hwy 99 on east side Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: 300) 300 Page 2 137.58
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replace water service to two buildings Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Portland Plumbing Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Dan White
Roof drain (commercial) 12.51
Address: 16260 S. Hilltop Sink/basin/lavatory 25.02
City /State /ZIP: Oregon City Or 97045 Solar units (potable water) 62.54
Phone: (503) 7238800 Fax: : (503) 7238801 Tub /shower /shower pan 12.51
E -mail: dan @portlandplumbingco.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Portland Plumbing Water piping/DWV 56.29
Address: 16260 S. Hilltop Other: 25.02
City /State /ZIP: Oregon City OR 97045 Subtotal 137.58
Phone: (503) 7238800 Fax: (503) 7238801 Minimum permit fee: $72.50
CCB Lic.: 162139 Plumbin ' no.: 3 -530pb
_ Plan review (25° of permit fee)
State surcharge (12% %
of permit fec) 16.51
Authorized signature: Q ' 1 TOTAL PERMIT FEE 154.09
Print name: Daniel L. White "^µ O / Date: 3 Sep 2012 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.
I:\Building'Permits\PLMU- PermitApp.doc 10/01/09 4404616T(10 /02/COM/WEB)