Permit .I' =a CITY OF TIGARD PLUMBING PERMIT
® :-: COMMUNITY DEVELOPMENT Permit #: PLM2009 -00341
T tGRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/02/2009
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Parcel: 2S112CA08300
Jurisdiction: Tigard
Site address: 7582 SW ASHFORD ST
Subdivision: RENAISSANCE WOODS Lot: 9
Project: Yost
Project Description: Replace up to 100' of water service.
Owner: FEES
YOST, JEFFREY W & STACIE L Quantity Description Date Amount
7582 SW ASHFORD ST
TIGARD, OR 97224 100 If Water Service 12/02/2009 $62.54
PHONE: 1 12% State Surcharge - 12/02/2009 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 12/02/2009 $9.96
Contractor: Plumbing
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503 - 239 -8801
FAX: 503 - 669 -9568
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 ques NC by calling 503.246.6699 or 1.800.332.2344.
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Issued Bj/: Permittee Signature:
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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.
1) 1. 2009 9:28AM No. 6123 P. 1
Plumbing Permit Application RECEIVE*
Building Fixtures . ; x
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1'3ns} } Ci of Tigard DEC U 1 200 ! Received
k., r3 ' �' ' Dated! ; ` A Permit No.:QI mz QO9 • 03 G
u 13125 SW Hall Blvd., Tigard, OR 97223
_ P hone; 503.63 9.4171 Fax 503.598.1960 , o ten Review Other Permit No.:
�� �' CIT OF �'• at elAy:
Inspection Line 503.639.4175 BUI LDING DIVIS � ; Ready/By: 's; El See e for
Pn 2
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5r Internet: www.t ouGed/1 letlied; Su temcniot ittrornieliori
T1'PE Of WORK - FEE* SCHEDULE
❑ New construction ❑ Demolition For special Information use checklist.
Description 1 Qly. 1 En. 1 Total
a ddition /n 'term ion/replacement • ❑ Oilier: New I- 2 -family dwellings (includes 100 11. for each utility connection)
CATECORY OF CONSTRUCTION • • SFR (1) bath 312.70
krZ)and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/ kitchen 25.02
❑ Master builder ❑ Other:
_ Fire sprinkler ( sq. R.) Page 2
.10E SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address:
r 2 LA I - '-' - - - Drywell, leach line, or trench drain 18.76
City /Slate /ZIP: / /
`' Fooling drain (no. linear It.: ) Page 2
Suite/bldg. /apt. no.: ' Project name: ` --t Manufactured home utilities 50.03
Cross street/directions 10 job site: Manholes 18.76
Rain drain connector 18.76
Sanitary Sewer (no. linear II.: ) Page 2
Storm sewer (no. linear R,; _) Page 2
--- Water service (no. linear 0..S0 ) 1 Page 2 (oA, cif
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Dackflow prcventer 31.27
• DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
p i 0 , c t , icktiet, K.Sp4- ✓e2..e - Dishwasher - 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
JJ'ROPERTY OWNER ...I • .. ❑ TENANT ., Expansion lank 12,51
Name: +r Fixture/sewer cap 25.02
- Address:
- ; „± Floor drain /floor sink/hub 25.02
Garbage disposal 25.02
City /Slate /ZIP: Hose bib 25,02
Phone: 6h 02- cool() Fax: ( ) ice maker 12,51
• .: . • AtAPPLICANT , ' • . ❑ CONTACT PERSON, Interceptor /grease trap 25.02
Business name: r Medical gas (value: $ ) Page 2
40 I _L At iv Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basinllavaloty 25.02
City /State /2IP: 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 37.52
Business na,ne. Ap j l f Q 71 60 " r14...02..
Water piping/DWV 56.29
Address 2-20 & n1.0 Lt. d1 y Other: 25.02
City /Slate /ZIP; 0x c)e ' �/ � Subtotal
Qy �j pT r`� LJ 5o
Phone: ( Z l 'd ?DI F0 : ) (Q( ) ' ' Minimum permit fee: $72.50 '
7,g CCB Lic.: • Plumbing Lic. no. 65 Fp: Plan review (25% of permit Ice) _
State surcharge (12% of permit fee) g. 70
Authorized signal') . t , f L Jam) "` TOTAL PERMIT FEE 8f � o10
Pain[ name: Y ���� Date:
This penult application expires If a permit Is not obtained within 180 days
�`/1 �� P z l O i after it has been accepted as complete.
W "Fce methodology set by Tri County Duildinp Industry Servi Dar .
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