Permit Support Document II
IIICITY OF TIGARD gril i PLUMBING PERMIT
•
COMMUNITY DEVELOPMENT Permit6: PLM2020-00076
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/24/2020
T I G;\R p g Parcel: 2S102DB06400
Jurisdiction: Tigard
Site address: 9107 SW HILL ST
Project: COOLEY Subdivision: CHELSEA HILL NO.2 Lot: 41
Project Description: REMOVE AND REPLACE GAS WATER HEATER. 3/4/20: REPRINT to removejl)water closet and add(1)water
heater.
Contractor: FAST WATER HEATER COMPANY Owner: COOLEY, ERIC J &RUTH A
11715 NORTH CREEK PKWAY, S#C-106 9107 SW HILL ST
BOTHELL,WA 98011 TIGARD, OR 97223
PHONE: 425-636-7084 PHONE:
FAX: 425-636-7055
FEES
Quantity Description Date Amount
1 ea Water Heater 02/24/2020 $37.52
Specifics: 35 Minimum Fee Adjustment- 02/24/2020 $34.98
Plumbing
Type of Use: SF 9 12%State Surcharge- 02/24/2020 $8.70
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 :7pr 1.800.3 .2344.
Issued By: 'I/ '2 J" Permlttee 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
Site Utilities FOR OFFICE USE ONLY
Received f e.2U wry?�
City of Tigard Receive Pe ��l%
71i • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503,598.1960 Date/By. Other Permit No,:
Inspection Line: 503.639.4175 Dace Readyl0y ®Janis: See Page 2 for
TtciARD Internet: www.tigard-or.•ov
6 6 Notified/Method: Supplemental Information
TYPE OF WORK_ FEE* SCHEDULE
❑New construction ❑Demolition bar special information use checklist.
Description f Qty. I Ea. f Total
❑Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
�j] 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
R.
Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler(_sq.ft.) Paget
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ci I b-i o w 1 ti 11 s i- Catch basin or area drain 18.76
�� Drywell,leach line,or trench drain 18.76
City/State/ZIP: 2
Footing drain(no.linear R.:_) Page 2
Suite/bldg./apt.no.: Project name: riD0) pe1 Manufactured home utilities 50.03
Cross street/directions to job site: `'"� Manholes 18.76
VRain drain connector 18.76
fC Sanitary sewer(no.linear ft.:_) 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 preventcr 31.27
DESCRIPTION OF WORK Backwater valve i 2.51
/�� n ^ Clothes washer 25.02
v a �s f Y`Q-.1) C e, ta at) Dishwasher 25.02
W��s it let Y//1, . J z/Cfz j fret"e- „s! Drinking fountain 25.02
•
6 N 5! U- 1 -/..-6. `l�`r? k( &iYr/l h /.,J- kee Ejectors/sump 25.02
❑ PROPERTY OWNER 0 TESIANT Expansion tank 12.51
Name: C(DO`p u �.�'G Fixture/sewer cap 25.02
Address: J I,, J r �. Floor drain/floor sink/hub 25.02
t Garbage disposal 25.02
City/State/ZIP: • N VOW. . / nS1111111111 Hose bib 25.02
Phone:(Sb3) 6219 3 6. G Fax:( ) Ice maker 12.51
0 APPLICANT .0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/hasin/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
CONTRACTOR • Water closet 25.02
Water healer 1 37.52
Business name: fat*, W( q( IAe„ A Water piping/DWv 56.29
Address: `�+•�` , ♦ :r / 1 al' Other: 25.02
City/State/ZIP: Q,O i .lA W Ql0ll Subtotal
Phone:(LAI& (34 elgI4 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: k 6 eg�Q Plumbing Lie.no.: p 6 1 3.3 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: ka kph k� Date: 1- - 4 s This permit application expires if a permit is not obtained within 180 days
J after it has been accepted as complete.
"Fee methodology set by-Fri-County Building Industry Service Board.
1:\Building\Permils\PLMU.PermiiApp.doc 10/01/09 440-46 16T(la/a2ICOM/WEB)