Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00127
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012
Parcel: 2S103DA07300
Jurisdiction: Tigard
Site address: 10910 SW MIRA CT
Project: Gualpo Subdivision: MIRA PARK Lot: 11
Project Description: Replace water service, approx. 75 feet
Contractor: EXCELLENCE PLUMBING LLC Owner: GUALCO LIVING TRUST
7520 SW 140TH AVE 10910 SW MIRA CT
BEAVERTON, OR 97008 TIGARD, OR 97223
PHONE: 503 - 643 -3459 PHONE:
FAX: 503 -643 -2815
• FEES
Quantity Description Date Amount
1 If Water Service 05/21/2012 $62.54
Specifics: 1 12% State Surcharge - 05/21/2012 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 05/21/2012 $9.96
Plumbing
Class of Work: OTR
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: Permittee Signature: , r [� 4 / A -� /�
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. rr'C •, C' , `(/ ~L.
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.
05/17/2012 16:17 5036262385 FEDEXK I NKOS 20 9 4 PAGE 02/02 of---
Plumbing Permit A licatio \f
Site Utilities • • •
MAY 17 2012 Reeeivntl PermitNo.p a�ola- Il'�Or.Z -7
City of Tigard Datd . err I -
4 13125 SW Hall Blvd., Tigard, OR 97223 ' 12 Plan Review Other Permit No.:
• Phone: 503.7182439 Fax: 503.598.1960 DateBy:
Inspection Line: 503.639.4175 Date Roady/By: Met, is p plemei Sec Page 2 for o.roMton
1 , c i A I I? Interact: www.tigard-or.gpv NotificdMkthad: 9n Nal Inf
• FEES' SCREi11JLE
0 Demolition F OS aperfal in ON us , e �� che { ckll � sx �
[] New construction DCmeripdon Total
60r Additiem/alteration /replacement 0 Other: -f miltt dwellings ('includes . 00 tz connection)
1- 2 1 for ca utility ce on ))
SFR (1) bath 312 70
C1►TEGORY :'OF. ISiV C[i UGTIt)N;, ;, SFR (2) bath 437.78
® 1- and 2- family dwelling �Q Commercial/irdn.trial SFR (3) bath 500.32
0 Accessory building 0 Multi - family Each additional bath/kitchen 25,02
❑ Master builder ❑ Other: Fire sprinkler (_____ sq. ft.) - Page 2
' : ' :JOB •S ' II4OR . AT!Ol l .oits`: 1AcfAT16N : • . - Sit ndlltiem•
-'- Catch basin or area drain 18.76
Job site address: 10910 SW 11rra Ct. Drywall, leach line, or trench drain 18.76
City/State/ZIP: Tigard, OR 97223 Footing drain (no, linear ft: Page 2
Suitc/bldgJapt. no.: I Project name: Gnalpo Manufbctured horn utilities 50.03
Cross street/directions to job site: 110" Ave _Manholes 18.76
Ram drain connector 18.76
Sanitary sewer (no. linear ft.: , ,_) Page 2
Storm sewer (no. linear R: ,_) Page 2
Water service (no. linear ft.: 5) Page 2 62.54
Subdivision: 4 Lot no.: Fixture or item:
Backtlow preventer 31.27
Tax map /parcel no.: - 8ackwtrtcr valve 12.51
1)1 �� C1ft)ION::OF ~�Vrki[c Cl othes washer 25.02
Replace water service, app
cox. 75 feet Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,
, .= Expansion tank 12.51
•
1' ' RTY b Fit
pi, ture/scwcr cap 25.02
Name: - - Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/Statc/ZTP: Hose bib 25.02
Phone: ( ) Fax: ( )
lcc maker 12.51
-: Arl UCANT
I ` 0 LON',�1�'i' 'PE1tStyN' • interccpardgralsc trap 25.02
- , Medical gas (value: $ ) Page 2
Business name: _ - Pier 12.51
Contact name; Roof drain (commercial) 12,51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( )
Tub /shrnver /shower pan 12,51 Urinal 25.02
E - mail: Water closet 25.02
CbN�tCTOR .::
..... , ... .:.., . , .... ......., ......... ' Water heater
37.52
Busing name: Excellence Plumbing, LLC Water piping/DWV 56.29
Address: 7520 SW 140 Ave Other. 25.02
•
Subtotal
City/State/ZIP: Beaverton
Minimum permit fcc: $72.50 72.50
Phone: (S03) 643-3459 . Fax: ( )
Plan review (25% of permit fee)
,CCB Lie.: 17576$ filumbing Lic. no.: PB3 1 State surcharge (12% of permit tie) R.70
f T OTAL. PERMI I'SF 81.20 /
Authorized signature: .
iL. ....s..41 ��L/ 1
This permit application efydrea it n p not obtained within Ian days
Print name: Shelly Eugenio / Date: 5.17.12 milt ie after k ham been accepted as complete.
"Fee methodology set by Tri- County Building tndmny Service Board.
I:Uiuild'mg\Pm rm\I MU- 1'ermltApp.doe 10101/09 440.4 16T(10102/COM/Waa)