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Permit CITY OF TIGARD PLUMBING PERMIT a : COMMUNITY DEVELOPMENT Permit#: PLM2012 -00341 T 6 GARD • 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012 Parcel: 2S103CA03400 Jurisdiction: Tigard Site address: 11555 SW TERRACE TRAILS DR Project: Bergstrom Subdivision: TERRACE TRAILS Lot: 6 Project Description: Replace 75 ft. water service Contractor: APOLLO DRAIN & ROOTER SERVICE Owner: BERGSTROM, DENNIS 2208 NW BIRDSDALE #8 11555 SW TERRACE TRAILS DR GRESHAM, OR 97030 TIGARD, OR 97223 PHONE: 503-239-8801 PHONE: 503 - 239 -8807 FAX: 503 - 669 -9568 • FEES Quantity Description Date Amount 75 If Water Service 11/20/2012 $62.54 • Specifics: 1 .12% State Surcharge - 11/20/2012 • $8.70 Plumbing Type of Use SF 10 ea Minimum Fee Adjustment - 11/20/2012 $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. /� A l Issued By: Permittee Signature: o f ( 4 Ppi-i TI D l -4 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. Nov. 19. 2012 11:07AM Apollo Drain No. 4142 P. 1 a ( 4_,-- Plumbing Permit Applic • 0 Building Fixtures ,. i . 'I, FOR OITIC •: I si: ONIA' City of Tigard AA''nn aCE1`'`d I > Permit No,: DL/l ( :4 n 13125 SW Hall Blvd., Tigard, OR 971131 �'' D'trB ' D S� �I��D; Ph one: 503.718.2439 Pax: 503.598.1960 • Plan Review � Other Permit No.: • /� DateB . r l v r� R D Inspection Line: 503.639.4175 no OFT C : r t �� Date Ready/13y. ® See Page 1 for Internet: www.tigard•or.gov .1T%; Notified/Method: li Su. ,lementol Information ; r.lx:a;v;,• ,, _ ...a, z __ _ ,, .:;__...,,t . - • - - . t,. r.,,� II'j el„�iit {„.{.I•`�iik�y, =- A.,L`� - _._ - -. ; - 6 ' e` - _• °h:;! •i:'n,.p_�ti Ali" ��`11` ! !1 .•L�Itf�.ni'...F1d1.'t2: ' .: '........r . .' ',•.�'- '' •: i%dr gi CI New construction ,. iii T;T1 � i" 1, %. I : ' i , ..2yr 1 ` t �.Y ?rP: 1 :lljli :r ;;t; 'i} G �?:_ - .. - For special information use Checklis El Demolition : :'.h_A � it r, h.;.`jis �L �lir.i t r F - + ddition/alteration/replacenlent ❑ Other. IS Description I Qty. I Ea. I Total '•� r(:"�L- �.. x,?* ?i.iF.w;�Ej! " arir;;;�::,i'cii�9 I.;; 1s•p il: 'r• "-ar#4i,. -� - c?e ► . ,1 4+Isb i "�'`•:�,, 4 °i `I ' r�'"' �^lii i " New 1 - 2- family dwellings (includes 100 ft, for each utilittcanncction) SFR (I) bath • 312.70 0 I- and 2- family dwelling ❑ Commercial/industrial - SFR (2) bath 437.78 ❑ Accessory building ❑ Multi - family SFR (3) bath 500.32 El Master builder ❑ Other. Each additional bath/ldtcllen 25.02 7 rr,;rpg, � -.n�rr . 2- -- -- s ... . - . ..• ..� . ,. - r i'il;Rlii• {,�� �c8 5, sibs a. ) cQ� l s�.a �.- -t� b -- -- _ :. t--. . ' ! ' n 1 : ;. I r e ; , ;'. : Fire sprinkler (� sq. R) Page 2 Job site address: ` 55 10 '�Af . I �i iM _ She utilities: G Catch basin or area drain 18.76 Ci /State2IP: ' • 0 ` ry �. !+ Drywell, leach line, or trench drain 18.76 - Suite/bldg./apt no.: r Project name: _ Fooling drain (no. linear ft.: ) Page 2 Cross streeUdirections to job site: Manufactured home utilities 50.03 Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft: ) Page 2 Storm sewer (no. linear ft.: _) Page 2 Subdivision: Lot no.: Water service (no. linear ft. : Page 2 Tax map/parcel no.: Fixture or item: s= :m_r rc r.-q1 u q r q > n�' yr'„ 'y B �? : �a� -'•' �t e 9 � e �i'4V a 5�<v.4. -� ^:,;�_� -- - _ _ reventer 31.27 p r,;; ; i ;Flt y �1- fs - i •���*�•�.�:b� �Ij'' - �, z ��if�? , Y�.�:n��n:;:1p+( c - _ - - - - Heckwatervalve 12.51 Clothes washer 25.02 Ilea U. a F i 'Si + .i�L Dishwasher 25.02 Drinking fountain 25.02 E- 4T �• ti ��r�,rr- - - �__ -�:•: - , 5.02 1 9t J f j` r -f-r.:-.4-741,i- - ; 8'3 i 'r;,. Ejeetas/sump 2 � 'i�- 1' ' °r`�F1:!.l�'!;`.1;�''r R.,'•9r },,,Il ���?. °'I��.t ` - -- .� ..i•�.'.n:.�,edt ;..1 ":i �i�� !y�t:l!� Name' i.. ?- Expansion tank 12.51 �� .� l A A. �( 1'fA Fixture/sewercap 25.02 Address: 11 .-- Il i a. at nIrMIE Floor drain/floor sink/hub 25.02 /� / A�� Garbage disposal 25.02 Phone: ■j ) *•l Fax: Gb) I r, . . / h Hose bib 25.02 t;fii . 17 = ,,l - 7 a�;";,•r`21 lee maker 12.51 ,��:�,tr•''_'.`f�� ©�' d r_ " �` �z-:. lt�l�`_ �; � e �J��+ � � '1k ? �'a..n_c. � 1c r;rL.r, ,, r 1. Business name: APOLLO DRAIN & PLUMBING SERV. INC Medi eptor/ (v a 2 Medical gas (vallue: ue: $ $ _) Page 2 Contact name: CHRISITNE KAFEL Primer 12.51 Address: 8 :, I B rip DL i ;: Roof drain (commercial) 12.51 City /Statc/ZIP: GRESHAM OR 97030 Sink/basin/lavatory 25.02 Piton=: (503) 239 -8801 Fax: : ( 503 669 -9568 Solar units (potable water) 62.54 E -mail: OFFICE @APOLLODRAIN.COM Tub /shower /shower pan 12.51 er • r:e - 1 .• � -r i : l : pr4� „r.- p. , p _ _ = �•c:•r.: {r rilJrina1 25.02 5 : ! :,l. i� + a cr a �� y ?. _,.___ y , �. , 1 4 � � lw L2 I.�. '13 ^:�r:7'•' ��� S r � i: . r1 ', .f<_s. !•k.bll;..., >. r e rte: �_�:.Z. Waterelosa 2102 Business name: APOLLO DRAIN & PLUMBING SERV. INC Water heater 37.52 Address: 2208 NW BIRDSDALE AVE #8 Water piping/DWV 56.29 City/State/ZIP: GRESHAA• - • s 0 Other - 25.02 Phone: ( 503 239 -880 r/'L1 ( 03) 669 -9568 Minimum permit t' Subtotal r: CCB Lin.: 4941 4-MINIE1 L no.: 2y 533PB Plan review rg (22 %ofpermit fee) Authorized signature ',� ���� State surcharge (12% of pennit fee) Print name: �� i 1 , Date ,nn TOTAL PERMIT FEE V- alb 1111uildieglPermi ,s'PLMU•PemdlApp.doc 10/01/09 440- 1616T(tse2/COMlW5D)