Permit CITY OF TIGARD PLUMBING PERMIT
/1111 g COMMUNITY DEVELOPMENT Permit #: PLM2013 -00006
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/07/2013
Parcel: 2S 101 DB00701
Jurisdiction: Tigard
Site address: 7275 SW VARNS ST
Project: Rusk Subdivision: ROLLING HILLS Lot: 1
Project Description: (1) water service, (1) water heater replacement (1) water piping
Contractor: CRAIG ANDERSON PLUMBING INC Owner: RUSK, RAYMOND R & PATRICIA J
2730 SE 15TH AVE 7275 SW VARNS ST
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503 - 232 -1060 PHONE: 503 684 -9722
FAX: 503 - 232 -5263
FEES
Quantity Description Date Amount
100 If Water Service 01/07/2013 $62.54
Specifics: 1 ea Water Piping /DWV 01/07/2013 $56.29
1 ea Water Heater 01/07/2013 $37.52
Type of Use: SF 1 12% State Surcharge - 01/07/2013 $18.76
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $175.11
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. /� --7 f ,
/9 /1 1A 4 j
Issued By: Permittee Signature: 2 I s o." c .4 ( e2
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 Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
1,1 - Cite of Tigard 07 7 l ( I � 3 s Permit \n. app 3- ct°
a 25 S W I tall Blvd.. Tigard. OR 97 2013 I Date: Br.
13 I _ S ��++ Plan Rcoie
• Phone: 503.7.18 24 39 Fay 503.548.196[t Dale.'3y Diher Perini] No
T I GARD I nspc+ ion Line: 503 63) 4l 75 � � �� � Dn Dale itcudy'lir: El See Page 2 for
Internet: ++1 +lv.ug::rd or.cot' 1�1W Vot.ried•1N 1 10. Supplemental Information
,•YPE O , j�INGDIVISION I FEE* SCHEDULE
['New udnstnlclion I ❑ Demolition
For sjreciu(information i.se checklist
Description I Qty. I Fa I Total i
I Addition/alteration/replacement I ❑ Other: New I- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
Ettl I- and 2- family dwelling I SFR (2) ba :h 437.78 • ID C'ummerciaUindustrial
SFR (3) bath 500.32
I ❑ Accessory building t ❑ Multi -family
Etch additional bath/kitchen 25.02
El Master builder ' ❑ Otter: , Fire sprinkler it sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION • Site utilities:
Job site address: 0 705 .
6 t.) 1/LL I' n s 31- . Catch basin or area drain 18.76
Urywell, (each line. or trench drain 18.75
CitylState;.IP: J l 3
1 0,,r(l. C / 9 .7 )
, / � � ` Fooling drain (no. linear It.: �) Page 2
' Suitc'hld2./apt. no.: Project name: ,if u k-- hMtutulactured home utilities 50 (13
Cross street/directions to job sit.: Manholes 18.76
Rain drain connector 18.76
I Sanitary sewer (no. linear ft.: _ i Page 2
.- - • .• - --- • Storm sewer tilt). linear ft.: _ i Page 2
Water service (no. linear li. /NJ } . l I Page 2 0,54
Subdivision: l.ut n;,.: I Fixture or item:
Tax map/pared no.: Backllaw preventer ) 31.27
DlsSCRIPIION OF WORK Backwatcrcalve 12.51
• y� Clothes washer 25.02
• ; +GZcS �.
� •� � � -�t` 1 f` e n JK.) /.' 1C I.0 l !I L�(LCtif 11t4 JcC� Dishwasher I 25.02
ti-- / .,• i(' ,LeLCk. /Y-L` )u( Drinking fountain 25.02
�
Ejectors::stullp 25.02
(g] PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
ry • � Fistttre!sewer cap 25.02
Name:
fC 44- P ! / -!_��1 Jt j i,5 k s _ Floor drain /floor sink/hub 25 02
Address: 1276 ,5 Lk) 11 11 t � o i - - I . Garba disposal 25.02
Cih•1Slat::/ZIP: 1 r ek . Ca ti" . 9 '7�I 3 Hose bib 25,02
Phone: (51;3 ) ic,t g.41 e.i 1,1.-- Fax: ( ) Ice maker 12.51
j APPLICANT ❑ CONTACT PERSON Intercepto:/grease trap 25.02 •
r �• y- Medical gas (value: S _) j Page 2
Rasimss name"
C r l r '1)G L I- •' ) � l l L i )11221:j .PC .' Printer I 1 I
Contact name: (1�G I €LJf'S/;)\ Rtwf drain (conuaerc :al) 12.51
Address: O j t ' Q A. / , J 11) f1.t . Si.,aasinilavntory 25.02
City /State/7..1P: lie-r' 1 i 1 a' 0 t C q--426).. Solar unit, (potable water) 62.54
Phone: (6(j 31 . .1 /04% I4% 0 Fax: : (.56 J) JJ J d ) -6j (G.J I 1'ubishower /shower pan tLS:
E-mail: 1 - C J / - / Uanal 25.02
l Water closet 25.02
C PR 1C OR , 37.52 �J7
�J Mater heater rJ S
Business name:` 1, -4.j � Andy' ‘,..--S').-1 tau,/ )c I7% /ll je_� Water piping DWV t 56.29 . 'j( (
Address: GZ 7 Y f.i 13 11 LL-L- LL-L- ,. Other: 25.
J 25.02 /Y _ 1J4 j / ; i5
[�i1y /``talc,' /.,1P: I��CI-itr� l l (.� ►��� ��/L. �7a.c� I Subtotal
Minimum perma Ice: $72.50
Phone: (tZ3 3 , - J fFax: (663 , ,9113 3
/L C ( . �A '"
•
C �/� p � Plan review (25% of pCnitit fee)
C•B Lie.: t r Pl um bing Lie. no.: 4c, -,,5 J U
State surcharge (1: ,e o fee) /3.16
Authorized signature: - I� iJ/ 14' I TOTAL PERMIT FEt{ ' /75 II 1
/ 'Ibis permit application expires if a permit is not obtained within 180 days
Print name: ` > 4 / 4 J ) l �.yJ i Dale: / X /3 after it had been accepted as complete.
` l• � "I'ee aredmdrlogy set by Tri- ounty Building Industry Service Bo:.rd.
I: IluitdinulPerm ,hs \P1.1.fl!- PermitApp.dac 1910 I!(ro •uryac l ST(10/02JCOM.WLln
l'd £9Z9 6uigwnld uosiepuy 6ieJ3 a 19:60 £ L LO uer