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Permit
Aim: Y4 CITY OF TIGAR® PLUMBING PERMIT ' k „ - COMMUNITY DEVELOPMENT Permit #: PLM2009-00346 if'4. Date Issued: 12/07/2009 i 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 itits.>ea - =n1 Parcel: 1S125DA03900 Jurisdiction: Tigard Site address: 6628 SW WALNUT TER Subdivision: Lot: 0 Project: Buhle Project Description: Replace water service from meter to house. Owner: FEES BUHLE, CHRISTOPHER J Quantity Description . Date Amount 6628 SW WALNUT TER PORTLAND, OR 97223 95 If Water Service 12/07/2009 $62.54 1 12% State Surcharge - 12/07/2009 $8.70 PHONE: Plumbing 10 ea Minimum Fee Adjustment - 12/07/2009 $9.96 Plumbing Contractor: BOB'S REEDVILLE PLUMBING 5976 SE ALEXANDER ST #C HILLSBORO, OR 97123 PHONE: 503 - 356 -8832 FAX: 503 - 356 -5245 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: R -3 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: PermitteeSignature: I / \' . V = r r A C r. 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. Dec 07 2009 10:2GAM HP LASERJET FAX p.1 Plumbing Permit Application 1 *1U R , HhIC[bGx\Lc.- . F614 .. Received Cfiy of Tigard pawn : Permit No.: . c y a,Q " bCS3 yli e tl 4 13125 5W Hall Blvd., Tigard, OR 97223 DEC 0 7 20 09 Plan Rmet Other Permit No.: :.= ! 0 Phone: 503.639.4171 Fax: 503.598.1960 patchy: i lf in spection Li ne: 503.639.4175 te ReadyfB I m.u. el See Page; for s��; r C ITY OF TIGARD Da rrt_ h. rat..ri Interne[: www. dgard - or.gov --�- i��p� Noli Su•plemenfal Information TYPE OF WORIPUILDllvla N 1 FEE* SCHEDULE ❑ Nev construction ❑ Demolition - For special in orm t. arion use checklist - Description Qty. Ea. Total Adklitien /alteration /replacement ❑ Other: _ -- _ - New 1 - 2- famil3, dweaings (include 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION - SFR (I) bath 1 249.20 1 tgf 1- ind 2 - family dwelling ❑ Commercial/industrial _ - SFR (2.) bath 350.00 ❑ Accessory building 0 Multi- Camity SFR (3) bath 399 OD - - -- - Each additional bath/kitchen 45.00 _ ❑ Mster builder ❑ Other: _ -_T._- Fire sprinkler ( sq. fl.) Pagc 2 _____ JOB SITE INFORMATION AND LOCA•17ON Site utilities _ Job sit address: p( a cL J LV�L h 14 t �t _ ^ - -^ Catch basin or area drain 16.60 City /SFate2IP: (A/' f - 7)43 D leach line, or trench drain 16.60 .. - -- Footing drain (no. linear R.: ) Page 2 • _ Suite/t)IdgJapt. no.: Project name: -�- - Manufactured home utilities 110.00 ' Cross ctrect/ditections :o job site: - -. J - r 1 G.60 _ -v Manholes 1 0)4 + 0 / J q I ' -- - ---_ Rain drain connector 16.60 i Sanitary sewer (no- linear ft.: 1 Page 2 -Fe? •, / I Storm sewer (no. linear fl.: _ _ _) Page 2 _ Subdi tsron: 1 Lot no.: Water service (no. linear 11.0_5_) f Pagc 2 Fixture or item Tax map /parcel no.: - -._ Absorption valve ( 16.60 DESCRIPTION OF WORK Backtlow pre-venter Page 2 jr a t! 6/1 (,i( y Backwater valve 16.60 6-1/1--(_-- Clothes washer 16.60 J Dishwasher 16.60 t - -- - - - Drinking fountain 16.60 L...' © j_ PROPERTY OWNER - -_ ❑ TENr5„ \_r_ - -- Ejectors /sump 16.60 Name: (" )) (A - - -- - - - �Y (5 _ -...-_ ___ ___- Eixpansion tank 16.60 Address; /(/. SL,) V UC" L t-( 4- >,r Fixture/sewer cap } 16.60 Floor drain/floor sink/ltuh 1 16.60 City /Scale /'LIP: Z'tl lei 0,- 7a-t)' -___ -- , j - � - - - - -- Garbage disposal i 16.60 _i_____ Hose bib 16.60 ❑ APPLICANT I ❑ CON A r i'ERSUN - - -------- .,..- __- -. - -- Ice maker 16.60 Busine�s name:fS7S 2a(!a � Vi j Cr 'V L4..y1 tic (_ C-C_ I Interceptor/grease trap - 16.60 - Contact name :7)c; e /'•Y1 / I - Medical gas (value: 5 ) Pagc 2 Address: 7i, Sr 4-i r_LAinaz V ,( - - - -T- ('rimer -. 16.60 City /State/ZIP: th )15 ,12 6-- (A-''' of 7 Id-3 Rcor drain (commercial) ' 16.60 Phone:1( 2} 354 - ?r3,- Fax: :(r )3) .5 5- Sink/basin /Invatory 16.60 To his hower /shower pan 16.66 E -mail - Urinal - - CONTRACTOR lVa[cr closet 16.60 __ Business name: yL,` __ _ Water heater - -- -- 16.60 Addres�: Outer! I City /S teal?: �_ -.- Subtotal] QU • - Minimum permit fee: 572.50 I Phone: ( ) Fax: ( ) I Residential backflow minimum permit fee: 536.25 'id :SI l CCH Lie.: / k Plan review (2.5%ofpermit fee) a 3 3 P lumbing L no. , f � /3 I _- Authorudsignature: - ` State surcharge (12% ofpermit fee) .. t_ TOTAL PERMIT FEE i Lo Print name: " rr t Y1/4-54.1.- Ll)_itc_ 1 r=7 , •t his permit applicafiun expires irn permit is not obtained within ♦♦` ISO days after it has been accepted as complete. `Fee methodology set by "Fri- County Building Industry Service Beard.