Permit CITY OF TIGARD PLUMBING PERMIT
1111 ..'.. COMMUNITY DEVELOPMENT Permit#: PLM2013-00342
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/01/2013
Parcel: 2S112CA07100
Jurisdiction: Tigard
Site address: 15396 SW THURSTON LN
Project: Andrews Subdivision: ASHFORD OAKS Lot: 25
Project Description: Replacement of 50'of water service.
Contractor: APOLLO DRAIN& ROOTER SERVICE Owner: ANDREWS,WILLIAM R&LINDA M
2208 NW BIRDSDALE#8 15396 SW THURSTON LN
GRESHAM, OR 97030 TIGARD,OR 97223
PHONE: 503-639-3741
HONE: 503-239-8801
FAX: 503-669-9568
FEES 1
Quantity Description Date Amount
50 If Water Service 10/01/2013 $62.54
Specifics: 1 12%State Surcharge- 10/01/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/01/2013 $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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Not ication—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 dir questions to O\UNC by - g 503.232.1987 or 1.800.332.2344.
n Is ed By: � , Permittee Signature: ji.,,��j/
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 Applicati
nCEIVED
Site Utilities FOR OFFICE USE ONLY
1('" r1 Received
City of Tigard (I,. I 1 �:13 Date/By: �v / / 3 I Permit No.: L i /3j_0o 3 .2
a 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.�si OFTIGARD Date/By: Other Permit No.:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Jur;s: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New l-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
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:
539IP 5.0 .Thu.+(S1UV`)�• Catch basin or area drain 18.76
City/State/ZIP: 7'9atd (,� 9� / Doting leach line,or trench drain 18.76
/ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
--r 7(10,f Ord St Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:50) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Di washer 25.02
51D1 w^W^ u L � Dishwa sher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: / 1 . A tL.5 Fixture/sewer cap 25.02
{• Floor drain/floor sink/hub 25.02
Address: /55i90 5u) nuutf sl r- LN
Garbage disposal 25.02
City/State/ZIP: 'TL�an d i 0(Z 91ga
Hose bib 25.02
Phone:(5LP ) (p3L 37,4 Fax:( ) Ice maker 12.51
❑ APPLICANT s--CONTACT PERSON Interceptor/grease trap 25.02
n _d& D `� J r Medical gas(value:$ ) Page 2
Business name: (.C,I �/
Primer 12.51
Contact name: 01,1-15 C, Kai(- Roof drain(commercial) 12.51
Address: Ala/✓W 6Ldivt , Ste x Sink/basin/lavatory 25.02
City/State/ZIP:ak(,e))1•Q,/I -� 0K_ 9?o30_3SW Solar units(potable water) 62.54
Phone:(5e 81- �pfu� Fax::(503)(Olt/ 154 Tub/shower/shower pan 12.51
E-mail: CMS t2./L,(,Oaaa(&d "., ,Cor-i Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: n„ o Qr2UA O iI Water i in /DWV 56.29
Address:aN)o / ,(4 S-tt g Other: 25.02
City/State/ZIP: Di1iz/VL 19 Dew Subtotal
Fax ( i„/„G 95/Per Minimum permit fee: $72.50 7,a.50
Phone:(5CS•3 )$3d� (0 � Sd3)
Plan review (25%of permit fee)
CCB Lic.: ycppg Plumbing Lic.no.:a�7 State surcharge(12%of permit fee) ,7E
Authorized signature: TOTAL PERMIT FEE 3/.. -C.)
/C
Print name: /f rls Qk(�- Date: 101,h3 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.
t:Building'Permits\PLMU-PermitApp.doc IO/01/09 440-4616T(I0/02/COM/WEB)