Permit n CITY OF TIGARD PLUMBING PERMIT
0 COMMUNITY DEVELOPMENT Permit #: PLM2009 -00065
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/24/2009
Parcel: 2S104CD10600
Jurisdiction: Tigard
Site address: 13697 SW TRACY PL
Subdivision: Lot: 0
Project: Mistry
Project Description: Replace (100) feet of water service
Owner: FEES
MISTRY, ASHISH N & RITA A Quantity Description Date Amount
13697 SW TRACY PL 100 If Water Service 03/24/2009 $55.00
PORTLAND, OR 97224 1 12% State Surcharge - 03/24/2009 $8.70
PHONE:
Plumbing
18 ea Minimum Fee Adjustment 03/24/2009 $17.50
Contractor: - Plumbing
AMERICAN RESIDENTIAL SERVICES LLC
P.O. BOX 2830
CLACKAMAS, OR 97015
PHONE: 503 - 235 -8784
FAX: 503 -491 -2932
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:. �Q WijlAji\ Permittee Signature
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.
•
• 10G-24.2004 15:13 P.001
Plumlbin2 Permit APPlicatio F�CF \(EO
Fixtures C
Building FOR orrl<:h USE ()NIX
City of Tigard M A R 2 3 2009 Received
q 13125 SW Hall Blvd_, Tigard, OR 97223 mites mites , �.� QQ _ Penn,t No ', �.= aQ (�/
Phone. 503 639.4171 Fax 503 508. I fry OF TIGARD Plan Re ieN
. : giber Permit
No
Inspection Line: 503 639 417 nspon ne: 5 t D
T I ^ r` ° Internet: �,�,� tigard -or gov BUILDING DIVI S IOi� 1 Daie Rea B> > • @J See Page 2 for 1
Nonlle•Mctltod . Su.plamentul
TYPE OF WORK FEE* SC EDULE
[] Nevi construction ❑ Demolition For special ityromtation use checklist
5 Description I Ot} Ea. 1 Total
Addi tion /altcration/replacement ❑Other: New I- 2- family dwellings (includes 100 R. for each utility connection(
CATEGORY OF CONSTRUCTION SFR i 1 i bath 249 20
'i4 I. and 2-family dwelling ❑ Commercial /industrial SFR 0) bath IIIIIIIIIII�
0 Accessory building 0 Multi - family SFR (3) bath 399.00
Q Master builder ❑ Other Each additional bath/kitchen 45
Fire spnnkler 1 sq. 114 Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1-' E 74, -.4e.i pG Catch basin or arca drain
16 60
City /State/ZIP: 77614 ,� Drywell. leach line. or trench drain 16,60
Suite/bldgJapt. no.: Project name: 44/5 I Footing drain (no. linear R. �l Page 2
Cross street /directions to job site: Manufactured home utilities 1 10.00
-_ Manholes 16.60
Rain drain connector 16.60 IIII
Sanitary seater (no. linear tf - `) P age 2
Storm sewer (no. linear h Page 2 ME
Subdivision: Lot no.: Water service (no linear ft.. Page 2
. fay map /parcel no.. Fixture or item
Absorption valve 16.60
DESCRIPTION OF WO Backflow premier Page 2
• I ' . N ` & [..& Backwater valve 1660
/ Clothes washer 16.60 MII
Dishwasher . arm
- -- PROPERTY OWNER ❑ TENANT Dun king fountain 16.60
_ 157-g-41 Ejectors /sump 16 60 =
Name: MI Expansion tank 16.60
Address: ,3 .47 37) ,
Fixture /sewer cap 16,60
City /State/ZIP: r i •v 3 Floor dram/floor sink/hub 16.60
!'hone: ( W _; • ( ) Garbage disposal 16.60
4 APPLICANT 0 CONTACT PERSON Hose bib 16 60
Ice maker 16.60
Business name: ARS dba JACK HOWL /Rescue Rooter
— Interceptor /grease trap I6-60
Contact name: JOYCE DENNIS Medical gas (value: $ 1 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 $tnlJbasWlavator} 16.60
Tub/showcr /shower pan 16.60
E -mail: Jl1Y'CEnJACKNOWIC.COM
Urinal
16.60
CONTRACTOR Water closet 16.60
It
Business name: ARS dba JACK AOWK /Reseueooter Water heater 16.60 I i
Address: P.O. BOX 2830 Other Cit} /State/ZIP: CLACKAMAS, OR 97015 Subtotal
Minimum permit fee. $72 50 i.
Phone: (503) 235 -8784 Fax: (503) 491 -2932 Residential backfuw minimum permit fee: $36 25 . 0 . M oIr
CCB Lic.: 127325 PI w bing Lie. no.: 34-168 P Plan review (25% of permit fee)
State surcharge (12% of permit fie) Weil
Authorized signature: vr�UC/
J � J� F 'TOTAL PERMIT FE',
Print name: iii •� � W/ Thin permit application expires if a permit is not um I ,tTIV"'
180 dun after It has been accepted as complete.
• 503- 491 -2932 ' Free methodology set by Tn- County Building Industry Service Board
t Owld� n •i'ombis∎Pi MF -r Please FAX BAC