Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00371
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2012
Parcel: 1 S 125DA05900
Jurisdiction: Tigard
Site address: 6740 SW ALFRED ST
Project: Niehous Subdivision: KINGS VIEW Lot: 45
Project Description: Replacement of up to 100' of water service.
Contractor: CASEY'S PLUMBING Owner: NIEHUES, LOREA
PO BOX 30075 6740 SW ALFRED ST
PORTLAND, OR 97294 TIGARD, OR 97223
PHONE: 503-253-0030 PHONE: 503 - 244 -1337
FAX: 503 - 262 -8251
FEES
Quantity Description Date Amount
100 If Water Service 12/20/2012 $62.54
Specifics: 1 12% State Surcharge - 12/20/2012 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 12/20/2012 $9.96
Plumbing
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 • k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Ce . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or if ect questions to OUN ► • .Iling 503.232.1987 or 1.800.332.2344.
Iss ed By: ' Permittee Sig • - �,
.• / ._ .ice
Call 503.639.4175 by 7:00 a.m. for the next available inspecti. n 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.
Dec 20 12 05:44p Case's Plumbing 5032628251 p.1
Plumbing Permit Application
Building Fixtures kHz UFFIC'E t `F: ()NI 1
City of Tigard Lei Pe r mit No.: / /�
a 13125 SW Hall Blvd., Tigard, OR 97223 Datay.. /R �a t eet t (" 0 3 7 /
• Phone: 503.639.4171 Fax: 503.598.1960 Plan e/By`W Other Permit No.:
Inspection Line: 503.639.4175
T F G:� RD Date www.tigard or.gov Notified/Method: >uti. S la See Page 2 for
upplemental Information
TYPE OF WORK FEE* SCHEDULE
El New construction ID Demolition
For special in o mation use checklist
Description Qty. i Ea Total
ddition/alteration/replaccmcnt ❑Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
'and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities_
Job site address: Catch basin or area drain 18.76
lg ��„ , ‘'•-kk.f�tvc•{
m G Drywell, leach line, or trench drain 18,76
City/State/ZIP: r i yA C l 1 C''�- 1 Footing drain (no. linear f .: ) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Z (0 S-- l+ ( Rain drain connector I 18.76
` Sanitary sewer (no. linear IL : ) Page 2
• Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) ! Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
i. i' r'✓ l • F' Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
OPERTY OWNER I 171 TENANT Expansion tank 12.51
-- CYCf'C't Fixture/sewercap 25.02
Name: J
(� �� S f Floor drain/floor sink/hub 25.02
Address:
'1 4 L S 1'" t�v (C4 S Garbage disposal
25.02
( •74 Ca C ( ce ci:ic34-3 Hose bib 25.02
Phone: : ) , • -. Fax:' ) ,--)( C`�_ r / Ice maker 12.51
❑ APPLICANT ❑ J CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: S ) Page 2
. v l , ih C Primer 12.51
Contact name: ; " Case ,_;\ -, Roof drain (commercial) 12.51
Address: 7 C) . ?...)(1)(.. 5 Sink/basin/lavatory 25.02
City/State /ZIP: P -- k an c (' R C Z0 4.1 Solar units (potable water) 62.54
Phone: (a2) a) ._ -- Fax: : ( 'l) .D Loa -Sa 1 Tub/shower/shower pan 12.51
E -mail: c C>; 1 � A_ (i) _ , . C .L� 1'Y1 C C f-`!1 Urinal 25.02
` P Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: C asec �t,A.l Y�r1\ptY1 \ Water piping/DWV 56.29
Address: ( . -,>C 6e4. S Other. 25.02
•
City /State/ZIP: r . -\c nr,i t c ` cli 2_9,4 Subtotal
Phone: (5Z) a - -( 73 ` Fax: (d&?' ) Q 10 r-'`i 1 ` Minimum permit fee: S72.50 7,9 .60
o�
CCB Lic.: ' L` r 5N/ y Plumbing Lic. no.: a� .7 Is ? a Plan review (25% of permit fee) -
State surcharge (12% of permit fee) 8 ,7v
Authorized signature: 11 C( s. A 1 4 d..44/..,,k.
g
TOTAL PERMIT FEE i
Print name: U V t • o t e LtA'e d+ k Date: 12 C - 0.1 This permit application expires if a permit is not obtained within 150 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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