Permit • LA t o
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00104
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2009
Parcel: 1 S 135AA03702
Jurisdiction: Tigard
Site address: 8775 SW OAK ST
Subdivision: Lot: 0
Project: Cullinan
Project Description: Replace up to 100 feet of water service.
Owner: FEES
CULLINAN, RANDY J AND Quantity Description Date Amount
KRISTINA G, 8775 SW OAK STREET 100 If Water Service 04/30/2009 $55.00
TIGARD, OR 97223 1 12% State Surcharge - 04/30/2009 $8.70
PHONE:
Plumbing
18 ea Minimum Fee Adjustment 04/30/2009 $17.50
Contractor: - Plumbing
AMERICAN RESIDENTIAL SERVICES LLC
P.O. BOX 2830
CLACKAMAS, OR 97015
PHONE: 503 - 235 -8784
FAX: 503 -491 -2932
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Type of Use: SF
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 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 -0100. You may obtain a copy of the rules
Issued By: Permittee Signature:
In& • • a 0 A
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.
` 4 SEP`29 -2004 19:14 P.001
,,,
Plumbine Permit Application RECEIVE
Building Fixtures APR 28 2009 Fort OFFICE USE ONLY
City of Tigard Received ,
Permit No. y
HJI Blvd. fiord, 9 In/ OF TIG "a>, R " ""
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Ph 13125 one; 503639 Fax 503. _ 98 7233 . 1 D ate(R. ther Permit No •
T I c, A R D Inspection Line: 503 4175 B ILDING DIVIS .at Re
Internet: wr+w.tigard- or.gov d Supplemental Infarmatlon
lea Fl See Page I for
Nellited•Tdnhu
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TYPE OF WORK FEE* 'C ' EDMILE
❑ New construction ❑ Demolition For special Information use checklist
Descn,tiom Ql . y Ea. 'total
'Addition/alteration/replacement ❑ Other: New I- 2 - family dwellings (includes 100 ft. for each utility connectmni
CATEGORY OF CONSTRUCTION SFR (I) bath 249 2 ~-
VI I- and 2-family dwelling ❑ Commercial/ SFR (2 r 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.) P age 2
JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: r n '2 Catch basin or area drain WM
!
City /StatciZlP: L 45/7 . .. ,k Drywell, leach line. or trench drain 16.60
Suitt:/bldg. /apt, no.: Project name: ' r Imo. Footing drain (no. linear ft.: _,_„) Page 2
Cross .strect/directions to job site: Manufactured home uttlihcs 1 10.00
Manholes 16.60
-- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _ 1 Page 2
Storm sewer (no. linear ft.: ) Page 2
Water ater service (no. linear ft.:
Lot Page 2 ��
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK • Back-flow Page 2
ow preventer ` '
lr� rM i
<<� , Lr �� _ _�L�/ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 1660
jk I Drinking fountain - 16 6 � 0
PROPERTY OWNER � 'I'E(YANT
/ / Ejectors/sump 16.60
Name;
• A.i AA A ' / V J Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: ir / 7 Floor dratnlftoor sink/hub 16.60
Phone: ( 4 "d` ) Garbage disposal 16.60
Hnse bib
jAPPLICANT [! CONTACT PERSON , 1G,6o
Business name: AIRS /Rescue Rooter RS dba JACK HOWK Ice maker 16.60
er Interceptor /grease trap _ 16.60
Contact name: JOYCE DENNIS Medical gas (value S ) Page 2
Address: P.O. BOX 2830 Primer - 16.60
City /State /ZIP:CLACKAMAS, OR 97015 Roof drain (commercial) 16.60
Phone: (503) 235 -8784 Fax: : (503) 491 -2932 SiNJbasiMavatory 16.60
E -mail; JOYCEI6 JACKHO W K.0011f 1'ub /show er /sltowar pan I G.60
Urinal 16.60
CONTRACTOR Water closet
16.60
Business name: ARS dba JACK HOWL{ /Rescu® Rooter Water heater 16.60
Address: P.O. BOX 2830 . Other.
City /State/ZIP: CLACKAMAS, OR 97015 Subtotal -----
Phone: (503) 23,5 8784 F Minimum permit fee: $72.50 , z
tut: (503) 491 -2932 Residential back0ow minimum permit fee: $36.25
CCB Lic.: 127325 _ Plumbing Lic. no.: 34-168 P Plan review (25% of permit fee)
Authorized signature: � , State surcharge (12% of permit fee 1 ±�/,1
r „� Imo• -� 't TOTAL PERMIT FE I
�MPAPIe li 1 )0�',X, This permit application expires if a permit Is not ob t • *-a+
180 days after It has been accepted as complete.
*Fcc methodology set by Tri -County Building Industry Service Board.
1 ul,aldingmPemmims\PLMP.p. Please FAX-BACK t! • 503-491-2932
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