Permit CITY OF TIGARD PLUMBING PERMIT
': a • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00276
,T F G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/20/2012
Parcel: 2S 111 AD05400
Jurisdiction: Tigard
Site address: 8770 SW PINEBROOK ST
Project: Strahan Subdivision: PINEBROOK TERRACE Lot: 77
Project Description: 40 feet of water service •
Contractor: CROWN PLUMBING Owner: STRAHAN, BRIAN C & SHEILA M
5429 SE FRANCIS ST 8770 SW PINE BROOK
PORTLAND, OR 97206 TIGARD, OR 97224
PHONE: 503 - 771 -9449 PHONE:
FAX: 503 - 771 -9454
FEES
Quantity Description Date Amount
40 If Water Service 09/20/2012 $62.54
Specifics: 1 12% State Surcharge - 09/20/2012 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 09/20/2012 $9.96
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.
) 41.4
Issued By: Permittee Signature: Ok i A1�]/ A T70
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. r[r'r(�/ C•'fJ
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.
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Crown Plumbing 503 - 771 -9454 p.1
Plumbing Permit Applicat i ..E[�
site Utilities ►�1. FOR OFFICE USE ONLY
City of Tigard
U Reeei.
II • 13125 SW Ilan Blvd., Tigard, OR 91 2 o 0 2012 patel6y: ed Q' Permit No.: Pap( �� _��
Phone: 503.718.2439 Fax: 50 Plan Review
Inspection Linc: 501639.4175 �`I�FTIGARD Date By: Other Permit No.:
T t G'� R o BUILDING DIVISION Date eri/Me lu 8 See Page 2 for
Internet: www.tigard or.gov Notitted/Method: �f f Supplementallnformation
TYPE OF WORK FEE* SCHEDULE
❑ New constriction ❑ Demolition Fo special information use checklist
Description I Qty. 1 En. 1 Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler( sq. ft.) I j Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: 8770 SW Pinebrook St Catch basin or area drain 18.76
City /State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: Project name: Strahan
Manufactured home utilities 50.03
Cross street/directions to job site: Hall and Pinebrook 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.: Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
Tax neap /pare! no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
40' water service
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 2.5.02
Address: Floor drain!floor sink/hub 2.5.02
Gartxtge disposal 25.02
City /Stat Hose bib 2
25.0_
Phone: ( ) Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON interceptor /grease trap 25.02
Business name: Crown Plumbing Medical gas (value: $ , ) Page 2
Contact name: Joni Siderins Primer 12.51
Roof drain (commercial) 12-51
Address: 5429 SE Francis St
Sink/basin/lavatory 25.02
City /State/ZIP: Portland, OR 97206 ' Solar units (potable water) 62.54
Phone: (503) 771 -9449 Fax: : (5503) 771 -9454 Tub/shower/shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Crown Plumbing
Water piping/DWV 56.29
Address: same as above Other: 25.02
City /State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 • 72 , VV
1 CCB Lic.: 163063 P Lic. no.: P61136 Plan review (25% of permit fee)
� ' State surcharge (12% of permit fee) g.7 0
Authorized signature/ ( ( ��`_ TOTAL PERMIT FEE 'S I . ?4,..) I Print name: • Thi a li J C .J � C �! L'i $ � I Date: � /zG�i 2- This application expires if a permit is not obtained within 1.80 days
after it has been accepted as complete.
'Fee methodology set by Tti- County Building Industry Service Board
lf. Building 1'e,milApp doe 10101109 440- 4616T( IQ/02/COWKT•B)