Permit A _ �. PLUMBING PERMIT
t CITY OF TIGARD
'S" n
. COMMUNITY DEVELOPMENT Permit #: PLM2010 -00109
T (Gf1R 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/07/2010
Parcel: 2S103CCO5200
Jurisdiction: Tigard
Site address: 13615 SW 121ST AVE
Subdivision: Lot: 0
Project: McGinnis
Project Description: Replace /relocate up to 100 feet water service.
Owner: FEES
YOUNG, STEVEN P Quantity Description Date Amount
9745 HILL VIEW TER
SALINAS, CA 93907 100 If Water Service 04/07/2010 $62.54
PHONE: 1 12% State Surcharge - 04/07/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 04/07/2010 $9.96
Contractor: Plumbing
SHAWNZ PLUMBING, LLC
PO BOX 341
GRESHAM, OR 97030
PHONE: 503 - 516 -1816
FAX: 503 - 669 -7143
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.
1
Issued By: k._11-\ �l r ( , , lX l�(� ll (� - (, „ t , ( \ Permittee Signature: f i A.*
l l Call 5 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.
RECEIVED
Plumbing Permit Application APR 07
1 r � t� wo rth;5�!`'tCRa1044 j�1 's +'�"�'.fi .'��4^ ..4.4, i "' r v • Site Utilities �= ' _ x5 ~ :ro lz 4 01.. . I(1 I S l ONL Y =,.• . m
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, CITY O T'1GARD R eceived
City o f Ti Pert ��' pi rnXA
;Y plU ` �
i BUILDING DIVISION Dane/By:
. „I a 13125 SW Hall Blvd., OR Phone: 503.639.4171 Fax: 503.598.1960 Date/By an Revrcw
a!eB Ocher Permit No.:
tv ns ection Line: 503.639.4175
T;1GA'RDt I P Date ReadyBy: uris See l'age2for
Internet: www.tigard- or.gov Notified/Method: • ( Supplemental information •
TYPE OF WORK FEE" S cEI)ULE j
❑ New construction ❑ Demolition For special informarion use checklist
Description 1 Qty. 1 Ea. 1 Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 10011. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- 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. ft,) Page 2
JOB SITE INFORMATION AND LOCATION _ Site utilities: _
Job site address: 13615 SW 121' Avenue Catch basin or area drain � 18.76
Drywell, leach line, or trench drain 18.76
City /State/ZIP: Tigard, Oregon 97223
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: Project name: McGinnis Manufactured home utilities 50.03
Cross steel/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: 1 Page 2
Storm sewer (no. linear ft: 1 Page 2
Water service (no. linear 11.:45) 45 Page 2
Subdivision: I Lot no_: Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
1
Clothes washer f 25.02
Boringl" water service
Dishwasher 25.02
_ Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
•
Name: Fixture/sewer cap 25.02
•
Floor drain /floor sink/hub 25.02
Address Garbage disposal 25.02 1
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT D CONTACT PERSON Interceptor /grease trap 25.02
Business name: ~R Medical gars (value: S ) 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: ( ) I
Fax: : ( ) Tub /shower/shower pan 12.51
E- mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: ShawnZ' Plumbing, LLC Water piping'DWV 56.29
Address: PO Box 341 Other: 25.02
City / State/ZIP: Gresham, Oregon 97030 Subtotal 62.54
Phone: (503) 492.1011 Fax: (503) 492.7300 Minimum permit fee: $72.50 72.50
CCI3 Lic.: 161188 Plumbing L . •.: 26-767 _ Platt review (25% of permit fce)
Stale surcharge (12% of permit fa) 8.70
Authorized signature: TOTAI. PERMIT FEE 81.20
- ...
Print name Shawn Zangerle ' Date: 4.5.2010 I 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.
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