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Permit CITY OF TIGARD PLUMBING PERMIT 1111 ,',;'_ COMMUNITY DEVEL OPMENT Permit #: PLM2011 -00192 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/16/2011 Parcel: 1 S 133C000900 Jurisdiction: Tigard Site address: 14076 SW SPRINGBROOK LN Project: Nelson Subdivision: PEBBLECREEK Lot: 3 Project Description: Replacing 70' of water service. Contractor: THE PLUMBERS INC. Owner: NELSON, BRENDA 15808 SW UPPER BOONES FERRY RD 14076 SW SPRINGBROOK LN LAKE OSWEGO, OR 97035 TIGARD, OR 97223 PHONE: 503 - 348 -7698 HONE: 503 - 519 -6644 • FAX: 503 - 684 -1202 FEES Quantity Description Date Amount 70 If Water Service 06/16/2011 $62.54 Specifics:, 1 12% State Surcharge - 06/16/2011 $8.70 Plumbing Type of Use SF 10 ea Minimum Fee Adjustment - 06/16/2011 $9.96 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or • uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility - 'cation Center. ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dir: t questions to OUNC by I g .53.232.1987 or 1.800.332.2344. Iss ed By: I, / / Permittee Sig ature: • Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Jun 15 2011 1:29PM The Plumbers Inc. 5034694540 p.1 Plumbing Permit Application Site Utilities Foh 0141( I:: I. NI.: ON IA City f Tigard Received / � • 131 SW Hall Blvd., Tigard, OR 97223 y DateBy. ®� " AIP i GO/ 2 : • . Phone: 503.7182439 Fax: 503.598,112011 1. 5 Z Plan a g y C1Y Other Permit No. - 4 I t ; t . 1 Inspection Line: 503.639.4175 DateReadyBy: Tune: !8 See Page 2 for I nternet: www.tigard- or.gov GARD Notified/Method: Supplemental Information 11 71.. b.. , tril - ''"., 1 .. 1 t ; -- p i vi: Fi>!ii i - 6};°4 . 1A tP r2 ' y. - . 1 :1 .. 4" ,, 7ir i s !!;!: ='• t .:,4 4 - a - A „,a;, . � r..' ' :( x L x . f O• .: R3 3ed' y, : r ,� t -� I -• ..t5i:xyt•.. iit#��1Rtttlf #..s�?I f.+ •.�_.' - ; +: 1<✓4�N+�! <!t ??;��'� ...:.. .. ..... •• - z� .f :,,» ❑ New construction ❑ Demolition For special information use checklist Description ] Qty. I Ea. I Total - Addition/alteration/replacement ❑ Other: New l �., t. � ` ..:� .= � =- •uK� sv . ^�me : ,w* a ,t� ,,. �:, tr. , , 1- 2- family dwellings (includes ] OO ft. for each utility connection) ajai$ - ,r • � P � 14- . 1l,+s ll dj3;itl t aw k.4r. : t, ,, r ', . .. . n•�.t lf,0.04i3� SFR (1) bath 312.70 11 ;.1 1 . c . •r :i'}'.�..:?tIRVIt:. , '1£"` ' ,, ` °ri t ing'�a �.i:;! ti qty 1- and 2- family dwelling ❑ Commer©alfindustrial 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 , I r'' • K•r e of 4 y w i s, i i t ii t it ; rl i t 44; w' i ., .. Site utiliti es: ::.., .,,n >ac r .'Ytsa.d a ` ` Job site address: Catch basin or area drain 18.76 I� - :, 5W 0 vt w J'to KO el1a r � Dryweli, leach line, or trench drain 1836 CitylStatelZIP:"'r 0 Footing drain (no. linear fl.: ) Page 2 Suite/bldg./apt. no.: ( Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 - Sanitary sewer (no. linear ft.: __) Page 2 Storm sewer (no. linear ft.: _ ) Page 2 Water service (no. linear ft.:`70 `) Page 2 Subdivision: J Lot no.: Fixture or item: Tax map/pancel no.: Backflow prey enter 31.271 , Backwater valve ;,, , 12.51 �. °� � 4. � �I s_ s iri a ' �"ar �4(��a, { &u TS , , t >f itw c {� � ..r °. .i i s y w d a ._. •C �1 ._., . Fpp r 6. . " „ X. N�. J }t £4-0 Dis WS_4hCr 25.02 rC/ ^ f Dishwasher 25.02 Drinking fountain 25.02 - Ejectors /sump 25.02 ( ` , . e� { ; {Bs "tt3 1, s ',� ,, '7''': ": Rh' 141 !t4�P,.'' IA'',4:; Expansion tank 12.51 ..� °."4 4i .1; 1! ,& - ills ills;:. it e„�....Zi;:a ,). ., ,f .s s+it,i,s w �rtrs:a::.. Name: J. . A Sit Fixture/sewer cap 25.02 ame: Floor drain/floor sink/hub 25.02 Address: I ■ jIAJ PfL(-�e2� Garbage disposal 25.02 City/StateZl ey 7aa-3 Hose bib 25.02 Phone: (5V 2Z s e: Fax: ( ) Ice maker . 12.51 • a' i r ` 1 9 F r t _ =F� t p ' ap t . ` '' Inte /grease trap 25.02 =ice :, .tW ,� r . , . . w,. -. ., .r „ Business name: Ift '' Oa. r rr. lA-C. - Medical gas (value: $ ) Page 2 Contact name: l5 O . 6 f�Q+ t l3aWtI1_a � 12.51 � f Roof drain (commercial) 12.51 Address: `) S Sink/basin/lavatory 25.02 ,r� r City /State/ZIP: . 01 �' L alt.. Solar units (potable water) • 62.54 Phone: `'"'.,t S( G( 4 6, Fax: : .2ra&Lf /).0.? Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 ur 'ti I . • ar, . :4:;y,i :lt r3 - . " Water closet l f4 0g.. ;;FAI : l to t,,, f, e . r s - , t< Sl ,a - . ia s a4g „ d,. t, S iv , a,;, , . {::1 `� 25.02 y.Ry dl _ n x ur . a. -fl�,r: - .t ,::fi.v�'4ipti; ...tc.s�'..;:< -�:___ ____:its` Water heater 37,52 Business name: ¶L.L xi..- L Water piP�f�� 56.29 Address. 0% , t ( ,t f f 4.<<L,1 (&J Other: 25.02 City /State/ZIP: (.eA_V- x .f 2 6 . O t Q q6 �� Subtotal - Phone: ) Si GI 6,6 Fax:fir -' (Atli-Ha-Cr,- Minimum permit fee: $72.50 12.- CCB Lie.: U7'7 4-- 7/4 /3 PI bingLie.no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: 7 / / /y �r TOTAL PERMIT FEE 7�''t -j Print name: 3 ,� a . t A -e. S Date: ( / / 4/r, y This permit application expires if a permit is not obtained within 180 days after it has been accepted 29 complete. *Fee methodology set by Tri -County Building Industry Service Board r\ auiIdtag \eerniu'Pthtupe,mi1App.doc 10ro1/09 440- 4616T(10/02 /COM/WEB)