Permit iii ;. CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit #: PLM2009-00257
13125 SW Hall Blvd. Tigard OR 97223 503.639.4171 Date Issued: 09/17/2009
� Parcel: 2S112BD02200
Jurisdiction: Tigard
Site address: 14955 SW 79TH AVE
Subdivision: DURHAM ACRES Lot: 44
Project: Preston
Project Description: Replace 250' of water service.
Owner: FEES
PRESTON, KRISTIN N Quantity Description Date Amount
14955 SW 79TH ST
TIGARD, OR 97224 250 If Water Service 09/17/2009 $147.80
PHONE: 1 12% State Surcharge - 09/17/2009 $17.74
Plumbing
Contractor:
GRAVITY PLUMBING
14935 S GREEN TREE DR.
OREGON CITY, OR 97025
PHONE: 503 - 490 -0763
FAX: 503 - 650 -3866
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $165.54
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 is . •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • ification Center. T • e r - are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir -ct questions to OUNC .. ailing 1 . or 1.800.332.2344.
Iss. ed By: // ' Permittee Signature: 1 /
1 / LL��...L r. �•, s. .l
CaII 503.639.4175 by 7:00 a.m. for an inspection that busines- day.
This permit card shall be kept in a conspicuous place on the job site until co pletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
pp
Building Fixtures FOR OFFICE 1 -■SE ONLY
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Cl of Tigard Received p ermit No.:
1114
q 13125 f 25 r SW W Hall Blvd., Tigard, OR 97223 DDate/By: 7 r ! / O u-1 A q 00 57
Plan Review
D
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 Date Ready/By: !u ' . ®Se Pa e 2 for
TIGARD Y y B
Internet: www.tigard or.gov Notified/Method: It Supplemental Information
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 (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB' SITE INFORMATION AND LOCATION ` - Site utilities
Job site address: 14955 SW 79 Ave. - Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97224 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: Durham or Bonita
Manholes 16.60
Rain dram connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft. Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRD'T[t)N OFy WORK. Backflow preventer Page 2
Replace water service Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑, PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
' ' ' Ejectors /sump 16.60
Name: Robert Preston Expansion tank 16.60
Address: Fixture /sewer cap • 16.60
City/State /ZIP: Floor drain /floor sink/hub 16.60
Phone:( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
' : ❑- ,APPLICANT ❑ CONTACT PERSON°
- Ice maker 16.60
Business name: Interceptor /grease "trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax :: ( ) Sinlc/basin/lavatory . 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal _ 16.60
:. ' CONTRACTOR - Water closet 16.60
Business name: Gravity Plumbing Water heater 16.60
Address: 14935 S. Green Tree Dr, Other:
City/State /ZIP: Oregon City, OR 97045 Subtotal
Minimum permit fee: $72.50 �
Phone: (503) 490 -0763 Fax: (503) 650 -3866' Residential backflow minimum permit fee: $36.25 / y7
g Lic. no.: PB173 Plumbing , Plan review (25% of permit fee) .. L
CCB Lic.: 171135 7//3 ! 7(� �r State surcharge (12 %ofpermit fee) 7 , 7
Authorized signature: 4 .
` � • TOTAL PERMIT FEE //e5„ 33
Print name: Jonarthon tinkl Date: 9 -17-09 This permit application expires if a permit is not obtained within
1 180 days after it has been accepted as complete.
*Fee methodology cet by Tri- C'nunty Rnildinn Industry Service Rnard