Permit A '`•
CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT Permit #: PLM2009 -00086
T l GARD 13125 SW Hall Blvd , Tigard OR 97223 503.639.4171 Date Issued: 04/13/2009
Parcel: 1 S133DB04900
Jurisdiction: Tigard
Site address: 13145 SW WINTER LAKE CT
Subdivision: Lot: 0
Project: Elliott
Project Description: Replace 100 feet of water service.
Owner: FEES
ELLIOTT, SU T Quantity Description Date Amount
13145 WINTERLAKE CT 100 If Water Service 04/13/2009 $55.00
TIGARD, OR 97223 1 12% State Surcharge - 04/13/2009 $8.70
PHONE:
Plumbing
18 ea Minimum Fee Adjustment 04/13/2009 $17.50
Contractor: - Plumbing
CASEY'S PLUMBING
P.O. BOX 30075
PORTLAND, OR 97294
PHONE: 503 - 253 -0030
FAX: 503 - 262 -8251
Type of Use:
Class of Work: 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 -0100. You may obtain a copy of the rules
Issued By: / . � � ' 1 , ,, , `I , 1 ` Permittee Signature: Q AV\1 � ' Imo. -46 2 C'+C�` ' �On
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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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Apr, •OS, OS O- 1;;.37p Case's Plu g 5032628251 p. 2
Y- )tum oing rerinit AppllCanon
Building Fixtures C.) � ! O Q�! FOR OFFICE' USE ONLY
City of Tigard , Q Received
III 13125 SW Hell Blvd., Tigard Fax: OR 9722
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�QQ 09 DateBy: '910 LIA Permit No. V y"� )M20n9 - O
C Phone 503 639. - 503.� �" l�� Plan Reniew en VVVV r 11 L i J1 J
175
O � � �� Date/By: Other Pnu No :
T I G ARD
Inspection Line: 503.639.4 G9 Date Ready /By, lures See Page 2 far
Internet wtiv
w.tigard or:gov p�
v `Q`� Notdicd/Method Cj Sapplcmeotal Information
TYPE, OF WORK4✓ FEE* SCHEDULE
DULE
0 New construction 0 Demolition Forspecial information use checklist
Description I City I Ea I Total
Addition /alteration /replacement ❑Other: New 1- 2- family dwellings (includes 100 11 for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249 20
K 1- and 2- family dwelling 1 0 Commercial /industrial SFR (2) bath 350.00
Q Accessory building Q Multi - family SFR (3) bath 399
Each additional bath/kitchen 45.00
El Master builder ❑ Other:
Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 13 I cc S tz W /14-t'r l-ake_ C?v- Catch basin or area drain 16.60
City /State /ZIP: y` I CR aa3 Drywell, leach line, or trench drain _ ___ 16 60
Suite/bidg. /apt. no.: I Projcct name: Footing drain (no linear ft ) Page 2
Cross strcct/dircctions to job site:
Manufactured home utilities 1 10 00
(� Manholes. 1660
- - c Qa^-� Lc S•' ' Rain drain connector 16 60
Sanitary sewer (no linear ft. ) Page 2
Storm sewer (no linear ft.. ) Page 2
Subdivision: _ l Lot no.: Water service (no. linear ft. 45-o) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
Backflow preventer Page 2
W Ca —ce SetN cc P Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
ROPERTY OWNER I 0 TENANT Drinking fountain 16 GO
Ejectors/sump 16 60
Name: cat,` l Vote \--
Expansion tank 16 60
Address: 1') i4 Std (...01(1-1-e.-
Lake. -'I- Fixture/sewer cap 16.60
City / State/ZIP: ilQet,rel t Cie ell a .D ') Floor drain /floor sink/hub 16.60
Phone: (67:>3) 'C J 4, 2, Fax: ( ) • Garbage disposal 16.60
Q APPLICANT • . 0 •CONTACT PERSON Hose bib 16.60
lee maker 16.60
Business name:
Casc'-�s -mb
Interceptor/grease trap 16 60
Contact name: `-b....,``\. c-_
Medical gas (value $ ) Paee 2
Address: '� O • .- ,- 16 60
- ,� Primer
City / State/ZIP: •kl 1 0 2_ c r " i 2 04 Roof drain (commercial) 16 60
Phone: () '�- 0 Fax: : (3 ) alGa - 6 Sink/basin / lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
Cx.j, - Ca.L•4 - c c c e, 1r:Jtnt CLi
COLT CTO m Urinal 16.60
Water closet 16.60
Business name: "S \4,1,- LrY rt- Water heater
16.60
Address: 0- U m X. - 3C 10 5 t 5 e Other:
City/State/ZIP: ?Ur�tu l Ce CA- -l `I 1 Subtotal
Phone: (� )_� ( Minimum permit fee. $72 50
Fax: , lqo� -$J1 Residential back-flow minimum permit fee. $36.25
CCB Lie.: 1 " L G1e. Plumbing Lic. no.:,„)tp- 12,5PaS Plan review (25% of permit fee)
Authorized signatu : tC r disc!. J t t }� Statesurdtarge(12 %of permit fee)
rJ.�1����tti� TOTAL PERMIT I'FE
Print name. fACLok - e. Lu-e d +kt_. Date: 1/ 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 1Buddins'Pcrm Its 1 PLMr- PermiiApp doc 12/27/06 440- 1616T( I O'UJCOMAV'EB)