Permit CITY OF TIGARD PLUMBING PERMIT
• ',�' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00284
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/09/2011
I IGARD 9 Parcel: 25111 BD00310
Jurisdiction: Tigard
Site address: 14570 SW 100TH AVE
Project: ROMMEL Subdivision: PEMBROOK HEIGHTS Lot: 10
Project Description: Replacing 40 ft. of water service. Electrical permit may be required if house grounding is affected.
Contractor: CASEY'S PLUMBING Owner: ROMMEL LIVING TRUST
PO BOX 30075 14570 SW 100TH
PORTLAND, OR 97294 TIGARD, OR 97224
PHONE: 503 - 253 -0030 PHONE:
FAX: 503 - 262 -8251
FEES
Quantity Description Date Amount
40 If Water Service 09/09/2011 $62.54
Specifics: 1 12% State Surcharge - 09/09/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 09/09/2011 $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.
Issued By: 1,/.-14 � / Permittee Signature: 61v
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. / V
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.
Sep 08 11 09:41a Case's Plumbing 5032628251 p.1
Plumbing Permit Application
Building Fixtures '? ECU/n:0_ FOR OFFICE USE ONLY
City of Tigard Received ( // Permit No.:
74 _ DateBy: // 1 W ' I) ZAJ t7W
q 13125 SW Hall Blvd., Tigard, OR 8 2 0 t 1 Plan Review 503.639.4171 Fax: 503.59&1960 O I Date/By: Other Permit No.:
Inspection Line: 503. 639.4175
TIGARD w -r� ir. }� Date ReadylBy: kris: La SeePage2
Internet: ww.tigard- or.gov /s � Notified/Method: Q Supplemental Information
�TY OF t cf
TYPE OF3W RI NG DMA StO! FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
tddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
t CATEGORY OF CONSTRUCTION SFR What 312.70
- and 2-family dwellin SFR (2) bath
437.78
ed.'?
y g ❑Commercial /industrial
❑ Accessory building SFR (3) bath 50032
ry g ❑ 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: 14-k 3 �.. \�(23.1�-\ 1 \--'� Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/ State/ZIP: �` C C-.. '.-. t l i r i Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: u J 1( I q V11 24 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
<_\ t= esY-1 - )y - ec'
Water service (no, linear ft.:(1(1) 1 Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
•
DESCRIPTION OF WORK Backwatervalvc 12.51
Clothes washer 25.02
L \Cc-;_-_
V ._,:..,..-A ; T (`S 1' V `( Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 2.5.02
r itOPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: ..\..1) w+-sc IVY-1 C ., fry Fixture /sewer cap 25.02
� Floor drain/floor sink/hub 25.02
<
Address: W L *V,._- c__ Garbage disposal 25.02
City /State /ZIP: -
-k--t G1/4.-Y -c I. 1 t ll k?- 0 1. �,--): ),{ Hose bib 25.02
Phone: (3{:?-)) U';'> it - .f-) Fax: ( ) Ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor /grease trap 25.02
Business name: �' a r m ' l Medical gas (value: $ ) Page 2
iVM Primer 12.51
Contact name: (et Sf, .
Roof drain (commercial) 12.51
Address: ? Q . TX;. '
Sink/basin / lavatory 25.02
City /State/ZIP: pr)t,--_\- con a t 0 R c '129 LA Solar units (potable water) 62.54
Phone: (° 0 i ,') - ) )_0 . X . -- 1 Fax: : ( �� -�) alDa_so 1 Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
� ��� �� >� �
X1 l�C cY`f1 Water closet 25.02
CONTRA
1 Water heater 37.52
Business name: n '1A A 0Y\ $Yl W ater piping/DWV P P g/DWV
56.29
Address:
(. x . rJ J Other:
25.02
City /State/ZIP: ,, .i4c c t 1 rte oil z ° &4 Subtotal
Phone: (5Q) ate?, -c)CV' 1 J �� Fax: (N ) '1 �_a Z 1 7� e
Q, Minimum permit fee: 572.50
CCB Lic.: ) L\--\ ci Plumbing Lic. no.: aI , V = )) _., ? Plan review (25% of permit fee)
State surcharge (12% of permit fee) S.,....
Authorized signature: tl c (Lc t 0 ( p . I TOTAL PERMIT FEE v
Print name: 1,( (.� iF _,,,,c1.-1-Kr Date: 9 - - 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.
I: 1Building1 Permits \PLMU-PermitApp•doe 10/01/09 410- 4616T(10/O2/COM/WFn)
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