Permit (21) CITY OF TIGARD PLUMBING PERMIT
: ' COMMUNITY DEVELOPMENT Permit#: PLM2016-00194
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2016
T I( A Iz.C7 9 Parcel: 2S112BB12600
Jurisdiction: Tigard
Site address: 14134 SW FANNO CREEK PL
Project: IRELAND Subdivision: COLONY CREEK ESTATES NO.4 Lot: 106
Project Description: Replacing 30 ft.of water service.
Contractor: PIONEER PLUMBING INC Owner: IRELAND, DAVID P
41474 SE BEAVERDAM ST 14134 SW FANNO CREEK PL
SANDY, OR 97955 TIGARD, OR 97224
PHONE: 503-701-1414 PHONE:
FAX:
FEES
Quantity Description Date Amount
30 If Water Service 04/12/2016 $62.54
Specifics: 1 12%State Surcharge- 04/12/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 04/12/2016 $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 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.
Issued By: - Permittee Signature:
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 1.0R 0141( r t S1: O\l.l
Received �/
City of Tigard ��
Date/By: 1-! 1 Permit No.: /�l M o ko,,, `1OI fy
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �"L! ta�V lf� U I
■ �l0`� Other Permit No.:
Phone: 503.718.2439 Fax: 503.598.y Q`��O Date/By:
I I c;-,I.i> Inspection Line: 503.639.4175 ` V 1, dQ , Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov • �Q Notified/Method: A,. �1-t Supplemental Information
7:1
❑New construction ❑Dem t• For special information use checklist
rf�� Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Ot[fat`\,4C),,,, ` New 1-2-family dwellings(includes 100 ft.for each utility connection)
�aT . SFR(1)bath 312.70
,..iin.«.�' '; ',',-ate d+ L,b n .a�uw..
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
El Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
* Site utilities:
Job site address:14134 SW Fanno Creek PI Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,Or 97224
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:Corner Fanno Creek Dr-Fanno Creek Place 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.:30) 1 Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
� 4= t �� ..,=°rs• ,_ Backwater valve 12.51
Clothes washer 25.02
replaced existing water feed line from the water meter to the house Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
g Expansion tank 12.51� ' :;)
Fixture/sewer cap 25.02
Name:David Ireland
Floor drain/floor sink/hub 25.02
Address: 14134 SW Fanno Creek PI
Garbage disposal 25.02
City/State/ZIP:Tigard,Or 97224 Hose bib 25.02
Phone:(503-)998-9103 Fax:( ) Ice maker 12.51
4 t Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:same
Roof drain(commercial) 12.51
Address:
-
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
€ w �� 'q, a. . Water closet 25.02
�-�A_ � �..".� .:� � ''„. .,..,�$14141IW; Water heater 37.52
Business name: /9,;.-p /Cpjr_ 4076:)'vq �� Water piping/DWV 56.29
Address: Ii/L1 -24./ S/-, 1( ___e 6,e,„.14.4 �1 Other: 25.02
` ^l J 4 C- '� 9 -?0..5---
City/State/ZIP: --' Subtotal
Phone:(50) ) 7 1 [`it-1 iy I Fax:( ) _ Minimum permit fee: $72.50 • 2 'S--4"
CCB Lic.:/SW, Plumbing Lic.no.: '"-'y'Yv��P.r3 Plan review (25%of permit fee)
State surcharge(12%of permit fee) �, 7 G
Authorized signature: �
��_ -_)11,--1112.1....-- TOTAL PERMIT FEE �i ,ZU
-� / This permit application expires if a permit is not obtsineo within 180 days
Print name: I� \ Date: LI
Off/ ( �o after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I\BuildingWerrnits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)