Permit a
�. � � CITY OF TIGAR® PLUMBING PERMIT
-' ° COMMUNITY DEVELOPMENT
TI O PERMIT #: PLM2007 -00521
DATE ISSUED: 11/21/2007
13 125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103AD -00507
SITE ADDRESS: 11180 SW ERROL ST ZONING: R - 4.5
SUBDIVISION: ECHO HEIGHTS LOT: 010 JURISDICTION: TIG
PROJECT: MEEKER
Project Description: Move clothes washer, add shower
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MEEKER, TIM JANE A
11180 SW ERROL ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/21/2007 $72.50
[TAX] 8% State Surcharf 11/21/2007 $5.80
Phone : 503- 367 -7601 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -318 -4593 (work)
Reg #:
This permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Specialty Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -0001 -0100. You may obtain copies of these rules or direct questions to OUNC
by calling 503.246.6699 or 1.800.332.2344.
Issued By: C?fyrj
Permittee Signature: /G 17/ge(16--
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.
. REGEWEt;
Plumbing Permit Applicat FOR OFFICE USE ONLY
DaDate/By: Other Permit No.: /f,/LG j _7 5
City of Tigard I " Received P
g Date/By: n-C Permit No.: I L� c .9,00 7 - v 0 > 5 '
a 13125 SW Hall Blvd., Tigard, OR 97 . t( �� C f47�€�1�� � J • Plan Review
C Phone: 503.639.4171 Fax: 503. :d. �� _ k , c�
Inspection Line: 503.639.4175 �� �� 1 � ''' �
T I G A R D Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental lnformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (l) bath 249.20
® I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11180 SW Errol St Catch basin or area drain 16.60
City/State /ZIP: Tigard, Or 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: 112th
Manholes 16.60 •
walnut, south on 112th, left on Errol, 1st house on right. Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: 2S103AD00507
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Move clother washer Backwater valve 16.60
Add shower Clothes washer 1 16.60 ii7
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Tim Meeker
Expansion tank 16.60
Address: 11180 SW Errol St Fixture /sewer cap 16.60
City /State /ZIP: Tigard, Or. 97223 Floor drain/floor sink/hub 16.60
Phone: (503)367 -7601 Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Tim Meeker Medical gas (value: $ ) Page 2
Address: 11180 SW Errol St Primer 16.60
City /State /ZIP: Tigard, Or. 97223 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (503) 367 -7601 Fax:: ( ) Tub /shower /shower pan 1 16.60 /64..,6-)
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: (t.- -iti yI 2/\ / Water heater 16.60
Address: Other: I
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7 s
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 31 yo
Authorized signature:
TOTAL PERMIT FEE if
Print name: 7 /, �� Date: / / /2,/ 7 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\PLM- PermitApp.doc 06/26/06 440.4616T(10/02/COM/WEB)