Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00385
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date issued: 12/10/2010
Parcel: 2S102CB03501
Jurisdiction: Tigard
Site address: 10040 SW GARRETT ST
Project: SORENSEN Subdivision: Lot: 0
Project Description: Replacing 70 ft. of water service. Electrical permit may be required if replacement piping affects house grounding.
Contractor: EXCELLENCE PLUMBING LLC Owner: SORENSEN, BROCK
7520 SW 140TH AVE 20 WALKING WOODS DR
BEAVERTON, OR 97008 LAKE OSWEGO, OR 97035
PHONE: 503 - 643 -3459 PHONE:
FAX:
FEES
Quantity Description Date Amount
70 If Water Service 12/10/2010 $62.54
Specifics: 1 12% State Surcharge - 12/10/2010 $8.70
Plumbing
Type of Use MF 10 ea Minimum Fee Adjustment - 12/10/2010 $9.96
Class of Work: ALT Plumbing
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Vir
Issued By: , Permittee Signature: M
C..i .3.639.4175 by 7:00 a.m. for the next available inspection date.
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.
CITY OF TIGARD PLUMBING PERMIT
i
4 = ` °. COMMUNITY DEVELOPMENT Permit #: PLM2010 00385
TIGARD 13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 12/10/2010
, Parcel: 2S102CB03501
Jurisdiction: Tigard
Site address: 10040 SW GARRETT ST
Project: SORENSEN Subdivision: Lot: 0
Project Description: Replacing 70 ft. of water service. Electrical permit may be required if replacement piping affects house grounding.
12/10/10, reprint to add (1) hose bib.
Contractor: EXCELLENCE PLUMBING LLC Owner: SORENSEN, BROCK
7520 SW 140TH AVE 20 WALKING WOODS DR
BEAVERTON, OR 97008 LAKE OSWEGO, OR 97035
PHONE: 503 - 643 -3459 PHONE.
FAX:
FEES
Quantity Description Date Amount
70 If Water Service 12/10/2010 $62.54
Specifics: 1 12% State Surcharge - 12/10/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 12/10/2010 $9.96
Type of Use: MF Plumbing
Class of Work: ALT 1 ea Hose Bib 12/10/2010 $25.02
Type of Const: 3 12% State Surcharge 12/10/2010 $3.00
Occupancy Grp:
Stories:
Total $109.22
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 i'cation CenTer Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or • ect questions to OUN . '-. 503.232.1987 or 1.800.332.2344.
Is ued By: ' Ln. Permistee Signature: ' �`
JAI" _tI AO ( —
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
12/09/2010 15:47 FAX 0]002/003
Plumbing Permit Application
Site Utilities ECEVED id'1l� 01 .1.1( 1. 1 4I O.\ I..1 1
City or Tigard Received
atc /B
. 1111 Datc/B / /ill !7 ,%I Penult No.: Pi M o t, 1LI — (10
. + 13125 SW Nall Blvd., Tigard, OR 9722 Pl C l• r 9 2010 Pla �D
II • Phone: 503.639 -4171 Fax: 503,598,1 Datc/t /By: By: w
Other Permit No.:
Inspection Line: 503.639.4175
I,I't,. n..ltc,I ):. Dato Ready/By: aurfe: RI gee Peat 2 for
Intoner. www.tigard- or-gov CITY OF TIGARD Notified/Method: ' 14 Supplemvntrd information
'wet of wIDING DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special lnformallon use ehecklijG
17cscrirtion •t . • Ea. Total
F Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437,78
Q Accessory building %Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. R,) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities; _ _
Job site address: 00 • Se , r / -5' r Catch basin or area drain 18.76
Drywcll, leach line, or trench drain 11111. 18.76 MIN
City /State /ZIP: 7"$ . r Oye QQ 7 Footing drain (no. linear R.: _) Page 2
Sulte/bldg./upt. no.: Project name: _ Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18,76
W'I r M d' 0 /ri- - Rain drain connector 18.76
Sanitary sewer (no, linear ft.:
Storm sewer (no. linear It.: ) Page 2
Water service (no. linear tt.: Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backlpw provcntcr 31,2'7
DESCRIPTION OF WORK Backwater valve 12.5!
Water �/ 7 _ Clothes washer 25.02
gap ) e , u ur PI a f 0 / ye X , t Bi shwesher 25.02
Drinking fountain 25.02
Ejectors /sump 1111M 25.02 MOM
❑ 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
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business nano: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address:
Sink/basin/lavatnay 25.02
City /Statc/Z1P: Solar units (potable water) 62.54
Phone: ( ) Fax; : ( ) Tub /shower /shower pan 12.51
E-mail: urinal 25,02
Water closet 25.02
CONTRACTOR
e h /i9� 6 Water poster 56.29
Business name: � e G
Watcr piping/DWV 56.29
Address: 1 i 1 9 e, Other 25.02 MIN
t
City /State/ZIP: � V" 1(7 /e, 9-700F Subtotal tom
Phone: ( 73 k13 - 3 1/5q Fax: (.Q, 4 5 2?/5 Minimum permit fee: $'12.50 125
/N r Plan review (25% of permit fee) --��
IL
CCB Lic.: / 5 27 Plumbing Lic. no.: ,53 State surcharge (12 of permit fee) 3' 7 #
Authorized signature: - 7 G - ie' TOTAL PERMIT FEE ; 20
Print name: Y It en/ Date: `Z q / ( 0 This permit application expires it a permit is not obtained within 180 days
attar it has been accepted as complete.
`fee methodology sct by Tri- County Building Industry Service Board,
I:100i1ding\Permiuli'LMU -I mltA pp. doe 10/01/09 440-616TOW02/COM/WP_13)
12/10/2010 14:28 FAX 0 001/002
Plain bing Permit Application cy ‘03.
Sith Utilities " ! ., C° 10 €.1 .►lc,OI:l1('1 . I tit 1),N1) •
City of Tigard ® Receiv
F 1 Phone: 503,639.4171 Fax: 503.598.19 �� C`O
DetcDate/By: Pernik Nn.P� /" /�' L}I� D
a 13125 SW Ball Blvd., Tigard, OR 97223 ��+
A nn Plan Roview
Other Permit No.:
€o9pection Line: 503,639.4175 0 (ft We: Datc :
I )1 . A I , 1 } " Dale Ready/By: e: 0 See epee 2 for
Internet: wWw.tigerd or.gpy V(I,V1 1•�" ^ � t � \ O Notified/Method: 5 Information
TYPE OF WORK `)� FEE* SCHEDULE
❑ New construction ❑ Demolition Par special lryformation use checkllat:
- Description I Qty. ! Ea, 1 Total
Q Addition /alteration/replacement ❑ Other: New 1- dwellings (includes 100 ft, for each utilitconnection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
0 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) balk 437.78
• 0 Accessory building - piv1u1Ii- Surlily SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ftJ Page 2
JOB SITE INFORMATION AND LOCATIO Site utilities:
Job site address: / 4 �a --.7t- Catch basin or area drain 18.76 T
City/State/ZIP: y� Drywoll, leach line, or bench drain 18.76
/ Footing drain (no. linter ft.: _) Page 2
• Suite/bldg. /apt no.: ( Project name: ra/7 Manufactured home utilities 50.03
! Cross streeUdirecti(ms to job site: Manholes _18.76
Rain drain connector T 18.76
Sanitary sewer (no. linear ft.: Page 2
Stone sewer (no. linear fl.: . ) _ Page 2 •
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no_: Fixture or Item:
Tax map/parcel no,: HackOvw prcvcntcr 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Ai / 4 • 1 11r / fl 0 '111 ' ' Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 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
City /State/ZIP:
Hose bib / 25.02i1d2
Phone: ( ) Fax: ( ) Ice maker 12,51
[] APPLICANT 0 CONTACT PERSON Intercepter /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
- - Primer 12.51
Contact name:
.. Roof drain (cotntnercial) 12.51
Address: Sink/basin/lavatory 25.02
City /Statc/ZIP: Solar units (potable water) 62.54 1
Phone: ( ) Fax: : ( ) Tub /shower /shower pan . 12.51
E -mail: ^ Urinal 25.02
Water closet .
CONTRACTOR ,
Water heater 37.52
Business name: X � � ‘ei /, # Water piping/DWV 56.29
Address: • S J / • ..F1 • . • - Other: 25.02
City /State/ZIP: V or , (7 7 0 0 r Subtotal
Phone: (,X03) , , 4/ 3 3g 'c Fax: ( , ) L 3 - 22' /5 Minimum permit fee: $72.50
• 75 7 / Plan review (25% of permit fee)
/
CCB Lie.: 75 ( Plumbing Lie. no.: 3Y State surcharge (12%° of permit fee) ,3 1 pd
Authorized signature: ' /2/ T TOTAL PERMIT FEE 27; 02-
Print name. ' ��� Date: /2 U T6ia Permit application expires If a permit B not obtained within 160 Jaye
after It has been accepted as complete.
*Fee methodology set by Th-County Building Industry Service Board.
I:\ Building \Parmits1PLMU- PemritApp.dpo 10/01/00 440- 4616T(10 /031COMJWt13)
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