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Permit (18) Plumbing Permit Application `s Building Fixtures rlFOR OFFICE USE ONLY City of Tigard Received �.�..�,� id/5- �^-, / / '. Permit No.: y�y /ter . mi 13125 SW Hall Blvd.,Tigard,OR 97223 ;1 Iv,,`,` Date/By: �) �l�` i5'CXR 3,^ Plan Review Phone: 503.718.2439 Fax: 503.598.1 a- , Other Permit No.: Inspection Line: 503.639.4175 ,•i. 1,,'r Date/By: TIGARD p t,.p Date Ready/By. Juris: ® See Page 2 for Internet: www.ti and-or. ov � '" g g ,;� �' , �4t Notified/Method: -"at Supplemental Information 0 New construction EllA 'i ition For special information use checklist Description Qty. Ea. Total 0 Addition/alteration/replacement ®Other:laterals New 1-2-family dwellings(includes 100 ft.for each utility connection) ', 1>,. 1 O 0 1 -. ,, , : SFR(1)bath 312.70 ^ El..-1----and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 El Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 i E 'oRL ATJ0J ! 'El Site utilities: Job site address:9430 SW McDonald Street Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,Oregon 97224 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site:SW 93rd and SW Elrose Court Manholes 18.76 Head south on SW 93rd Ave(flag pole for 9430 SW McDonald Street is adjacent to Rain drain connector 18.76 SW Elrose Court Sanitary sewer(no.linear ft.:152) 2 Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.:152) 2 Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.:2S111AB-03300 Backflow preventer 31.27 "r t : 'IkBackwater valve 12.51 t .r RIPTI©' i ; ° Clothes washer 25.02 2 Sanitary Laterals including line taps and install 2 water lines in flag pole. Dishwasher 25.02 and 4 clean outs Drinking fountain 25.02 r , Ejectors/sump 25.02 t.ligpi' §. , o 4t r q❑ T Expansion tank 12.51 Fixture/sewer cap 25.02 Name:Thomas and Traci Freni 0 Floor drain/floor sink/hub 25.02 Address:9430 SW McDonald Street Garbage disposal 25.02 City/State/ZIP:Tigard,Oregon 97224 Hose bib 25.02 Phone:(503)314-5893 Fax:( ) Ice maker 12.51 �ivideAlT ❑ COSRSi1 1 Interceptor/grease trap 25.024.-1.4t.:',,,,,..- ; € , Business name:Same as Property Owner Medical gas(value:$ ) Page 2 \�V Primer 12.51 Contact name: 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 Water closet 25.02 l ,. .,..",,.'7116,11'44o,, :. „rec.. ..: � . .. Water heater 37.52 Business name:Tryon Creek Landscape Water piping/DWV 56.29 Address: 11400 SW North Dakota Street Other: 25.02 City/State/ZIP:Tigard,Oregon 97223 Subtotal NZ, C2 Phone:(503)209-6909 Fax:( ) Minimum permit fee: $72.50 CCB Lic.:185802 - piumbing Lic •o.: Plan review (25%of permit fee) State surcharge(12%of permit fee) t J� Authorized signature: a ° s ,' TOTAL PERMIT FEE �. `� %�l This permit application expires if a permit is not obtained within 80 days Print name:/f' / n/1,�j" I r� Date: �Q ✓ after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:ABuilding\Permits\PLMU PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)