Permit •
CITY OF TIGARD PLUMBING PERMIT
111 • � , COMMUNITY DEVELOPMENT Permit #: PLM2009 -00087
Date Issued: 04/15/2009
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135CC00400
Jurisdiction: Tigard
Site address: 11640 SW TIEDEMAN AVE
Subdivision: Lot: 0
Project: Thaler
Project Description: Replace 15 feet of sanitary sewer.
Owner: FEES
CASS MORGAN THALER Quantity Description Date Amount
13475 SW 115TH AVE 15 If Sewer Service 04/15/2009 $55.00
TIGARD, OR 97223 1 12% State Surcharge - 04/15/2009 $8.70
PHONE:
Plumbing
18 ea Minimum Fee Adjustment 04/15/2009 $17.50
Contractor: - Plumbing
ENVIRONMENTAL SERVICES
3540 SE 28TH AVE
PORTLAND, OR 97202
PHONE: 503 - 234 -2118
FAX: 503- 331 -7133
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 • ' •• • - •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili • ' otification Center. Th.,- - rule are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Issued By: /� / ( Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that bu • ess day.
This permit card shall be kept in a conspicuous place on the io ' until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Von : So i 1 Solutions 503 331 7133 04/09/2009 12:11 #376 P.001/002
. .11 ■
• !,
‘'Y .. • . .
Plumbin . Permit Ai 1 lication 1. N NII tic
City of Tigard c s ,, 1 .
13125 SW Hall Blvd., Tigard, °R.97223 %
!•V: A V i ilecelie.n3vcdr: ew 4139 ' Oq Permit ND.: Pi on-7nociscicc 8 q
I ‘ In ,, , % nee Revi
Phone: 503.639.4171 Fax: 503.598.196t k 'f '. '•:.+;.:',„'`,, l '' ‘, . ' Ma Permit No.:
24- Hour Inspection Line: 503.639.
• \ - :- ''' ' • , N• Dale Ready/By: 1i Jude c 62 See Page 2 for
• Internet: www.ci.tigard.or.us ' • ' " " I' Notified/Method. Supplemental Information
: .--;,' ;' . : - .: OF: 1 Wtht 4 .‘ , ,A‘t %r,;:'; - :.:::' , ..:.;' ,1- . .- - .:. , : FEE*, SCHEDULE ' •• : ' ' : ::. ..' .. - •
special information use checklist.
0 New construction For spe
.._
I '
Description I Qty. I Ea I_ Total
% lb
ilaAddition/alteration/replacement c It o • -7: • New I- 2-family dwellings (includes 100 IL for each utility connection)
:1- .,;).f:':'4 . .;;;`•;': :, :c '. V SFR-( bath 24910
al
1- and 2-family dwelling 0 Cominercialfindustrial SFR (2) bath 350.00
399.00 •
0 Accessory building 0 Multi-family SFR (3) bath
• Each additional bath/kitchen 45.00
0 Master builder 0 Other:
Page 2
' ' " • '.: ' ' • ' ''JOB' SITE INFORMATION, AND:: LOCATION :';'; •: u
Job site address: I I Lal_f D c a J,3 T, s - RA Catch basin or area drain 16.60
_
City/State/ZIP: lick-%..a oicz qqa.a.3 .. Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bIdgJapt. no.: Project name:
Manufactured home utilities 110.00
Cross sireet/directions to job site: F...3 11" . &i--• .
Manholes • 16.60
Rain drain connector 16.60
-. Sanitary sewer (no. linear ft.: ja) _ f Page 2
Storm sewer (no. linear It: _.) Page 2
Subdivision: I Lot no Water service (no. linear ft.: ,___) Page 2
Fixture or item
Tax map/parcel no.: -
Absorption valve 16.60
_ .
1 ; -:::: .• .; :'':',' :''',,'• •:::':::■-:•,;:::•••":: 1 . ':::::. ) F4 4 7*irilicO''itif!'*0.0c , :-4'. ' , , Backflow preventer Page 2 •
9- CA- QR.( j erc--- art o cykoe2,A.,.. Backwater valve 16.60
Clothes washer 16.60 .
e'll Ak ilAel,tt n.SLJUU- Jr.
Dishwasher .
16.60
-
16.60
; ,:•-::, :f,.... j0 ,.4 . ..,:.: :; Drinking fountain
Ejectors/sump 16.60
Name: 0-4/•>44 M5 Cc3,4^ Expansion tank 16.60
Address:- 1 5 iM '' 141Ptk Fixture/sewer cap 16.60
City/State/ZIP: T 7 ni 4 DR cf a a:3 Floor drain/floor sink/hub 16.60
Phone: ( ) * Fax: ( ) Garbage disposal 16.60
Hose bib 16.60 •
- -.. :-.:. ,.. .: ::' • R APPLICANT::: ', ••:: •:-.: .• •:',"•.:, rr.::::.:, : ..'
Ice Maker 16.60
Business name: 0-i \ a I U. . •.
Interceptor/grease trap 16.60
Contact name: \ lacl.. i f- 0 41 .... 11 - 4_,Lpv '‘,k, Medical gas (value: $ ) Page 2
Address: 51 ( SE_ 7 _ A Primer . 16.60
City/State/ZIP: . ?10)( .. _ Ofq ct-R_ - Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: 643 c941Lt - al I, R I Fax: : ( 5 7 ) / -71 '&S .
Tub/shower/shower pan 16.60
E-mail:
- : Urinal 16.60
16.60
Business name: Sni NU Mo eizgrx> Water heater 16.60
Address: Other
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 q a .50 ,
, CCB Lic.: u5F,--...iQ rd.6o \ ( Plumbing Lie. no.: z164.. Plan review (25% of permit fee)
Authorized signature:
State surcharge of permit fee)
_ _ •
TOT FEE .
C)
Print name: t‘t rbn 9-,Iir.s 0-ell Date: 4-9-07 J 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: 06/05 440-4616T(10/02ICOM/WEB)