Permit •
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00285
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2009
Parcel: 2S102DD00808
Jurisdiction: Tigard
Site address: 13960 SW 87TH CT
Subdivision: FILBERT PARK Lot: 1
Project: Curtis
Project Description: Connect existing house to sewer. 100' sanitary sewer line.
Owner: FEES
CURTIS FAMILY TRUST Quantity Description Date Amount
15285 SW ALDERBROOK CT 100 If Sewer Service 10/08/2009 $62.54
TIGARD, OR 97224
PHONE: 503-443-3925 1 12% State Surcharge - 10/08/2009 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 10/08/2009 $9.96
Plumbing
Contractor:
SAMMY LEE MUNSEY PLUMBING
11771 LONGSTANDING CT
OREGON CITY, OR 97045 •
PHONE: 503 - 333 -5499
FAX: 503 - 723 -4753
Type of Use: SF
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: /� - �) i Permittee Signature -p 1'
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
•
Pluinbtng Permit Application REcE ,
Building Fixtures r•OR orFich: lash. ()NIA
OCT 0 3 200' Receive
City of Tigard Permit No.: •
a 13125 SW Hall Blvd., Tigard, OR 97223 Date/B '� l�� �O'
Date/By: Review
C Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGAR JI Other Permit No. V"V V2 - CO I 5g
Inspection Line: 503.639.4175 BUILDING DIVISI i ate Read B Juris: ®S Pa e 2 for
Internet: www.ti
1 I C. A R D ard -Or. ov
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g g Notified/Method: • , Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
R Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
El 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ 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: 13 l ( a 81 h �1 Catch basin or area drain I 18.76
City /State /ZIP: V Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 0 if.Il13 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.:1 ) 1 Page 2 (P 2. St.f.
Storm sewer (no. linear ft.: Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
i Clothes washer 25.02
(10 n f Q C %� E 0'
11 S"I L t � ► r 10 1.5'E AC3 Dishwasher 25.02
' / 3 Q 1 r. Drinking fountain 25.02
Ejectors /sump 25.02
R PROPERTY OWNER I ❑ TENANT Expansion tank 12.51.
Name: (� i , -k S ml \ vktr�� Fixture/sewer cap 25.02
Address: \ / M � Ai g 5 .5. W. 4 0-e r b roo /� Court
rt Floor ge disposal sink/hub 25.02
Garbage disposs al 25.02
City /State /ZIP: ' d y d, Q ?7.224 Hose bib 25.02
Phone: (5) # .3 -• ,1'.2 5 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
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
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 0 , t11 11 . r Al ._ I ' Q . , . . -a A t (1 Water piping/DWV 56.29
Address: 4�'� 1 l L , 4 k,� t n ck( Iii� Other: 25.02
�+'
City/State/ZIP: �� t�, - i Q c3 4 , 1 q Subtotal (p2 5
Phone: (fijf)3) 33 2., 1.4 q C Fax: (5o3 - - 4 ?S3 Minimum permit fee: $72.50 72.50
�3
CCB Lic.: l ` (5 t Plumbing Lic. no.: Plan review (25% of permit fee)
l State surcharge (12% of permit fee) t , P50
Authorized signature: TOTAL PERMIT FEE g \ . 7_ 0
Print name: Date: 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.
I\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440.4616T(10 /02/COM/WEB)