Permit n CITY OF TIGARD PLUMBING PERMIT
"1 s • COMMUNITY DEVELOPMENT Permit #: PLM2013 00018
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2013
Parcel: 1 S 125DB07300
Jurisdiction: Tigard
Site address: 7155 SW SHADY CT
Project: Conley /Holstad Subdivision: SHADY DELL NO.2 Lot: 46
Project Description: (1) 65' water service
Contractor: MP PLUMBING CO Owner: CONLEY, MATTHEW P
PO BOX 393 HOLSTAD, TRACY R
CLACKAMAS, OR 97015 7155 SW SHADY CT
TIGARD, OR 97223
PHONE: 503 - 655 -9161 PHONE:
FAX: 503 - 655 -1726
FEES
Quantity Description Date Amount
65 If Water Service 01/14/2013 $62.54
Specifics: 1 12% State Surcharge - 01/14/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 01/14/2013 $9.96
Plumbing
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 -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: s��c�Cr �� � s t 9 OR d_PPLici4nvA1
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.
Plumbing Permit A licatio C E�D
Site Utilities I I I It (I , I I l I I• I 11• I1
N...... City of Tigard Plon Received S Permit N r .
GI 13125 SW Hall Blvd., Tigard, OR 97 2 23 JA N 14 2013 Ry: r(I`�. 13 r t�C(3 �r� n n R eview
Phone: 503.7182439 Fax: 503.598 26cl y . Other Permit No.:
Inspection Line: 503.639.4175 1TY OF TIGARD Date Ready/By:
Internet: vAvwtigard- or.gov X111 N N
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Information
❑ New construction ❑ Demolition For 'din orn as use c/rerki&
Description t 1; '
Addition/alteration/replacement ❑ Other: New I -2- family dwellinga (includes 10011. for each utility connection)
.: , , << , • x ,t t-rigkOii/`),•. pF' QO1' 4CLl! ill;14T <: ; i:ig.l; w SFR 0) bath I 312.70
fJ I- and 2- family dwell ❑ Commercial/industrial SFR ( 2) bath 437.78
SFR (3) bath 50032
0 Acccaory building ❑ Multi - family
Each aaddit;rna l bath/kitchen 25.02
❑ Mastcr builds ❑ Other: - -- _ Page 2
_
.,. .. ,,,.'• - , 70D _ , Fire sprutklcr q
., ,..::'g.,i. •. - - .� �:q, ; ;.
'g•;:,. S 00#1lf .050 + x�ND,':;LOC1117ON:, :: Site oolitic
Job site address:NA S vi3 Shad ( Dv Jr. Catch basin or area drain 18.76
Ciry /StatePl[P: �r� � � � � �� �YW'cu, leach line, or trench drain 18.76
Q Footing drain (no. linear ft.: _) Page 2
Suite/bldg./apt. no.: 1 I Project name: 33227 Manufactured home utilities 50.03
Cross st eet/directionS to job site: Manholes 111.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: (Li) I Page 2 1.4.S4 .
Subdivision: • Lot no.: Fixture or item:
Tax map /parcel no.: l3ackflow preventer 31.27
CiF, lY•..fti I..2"- �';r• { ::1!K ti r y'9g1 : :1 ?'� ;�. 1 w ,,., Backwater valve 12.51
. �� °;.,,:; +,�::::'i:; ,. •: �l1P�t1PC1�09 !i.:OFSWORK:tit�:`f� ? l: ��':
�Q� I � n Cl othes washer 25.02
1\ f N V ` ' ^�' J � �� < �� ' I v I�JC Dishwasher 25.02
Drinking fountain 25.02
Fjcctors/sump 25.02
:„ 4 ., i „ :.,. 1,,,,• «,; :..:r:,•,;• Gxpmisnnr tank 12.51
vid}u,.4G ic� ...� ?wf'?!.I a R c'2:i:x. 1 d , ,rrC. ' .IA,.r:.1i.:4:en w ,,/ Ge'r` ti:•Y, , ",.4ie:'l.y, '
Name: mat. at r le 7 " J r aC". q -/; Pa' F l our :lscwcr cap 25.02
Address:
Flour draiNlltxtr sink/hub 25.02
Garbage disposal 25.02
City /Slate/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
.a' ?1:iT ,.. " F a t : D i d S. ir't .,� °.y . 1,. ; romp,, A�`G, r•;',V: Interceptor /grease Imp 25.02
+- :qtr- i. '.;e.:�ti,'n.: '..��...... '!. .:..
Business name: Medical gas (value; $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/21P: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
/I I A41 14 . Il.i / O1//
Water closer 25•{11
.:- -. , .•. " ., ' ..: <. . ` ... 1'0 Wasterh
( \ R - PI Ll i"rthl h A (�Q I' 1 h ,. W ater t ip in
Business name: � l !
�j `-'� n n t� WV 56.29
Adtbtsv: �17 � G1 0
�f 1 Otter. 25.02
City /State/ZIP lac c W y�� R -1 1 J. Subtotal 6 J'i
r � aA
r O / Minimum permit fee: $72.50 I a. S p
Phone: (�) fQ �� �� � Fax: ( SO (��?� � (� L�
CCB Lie.: SID a Plumbing Lic. no.: 3 >' r I -p,B Plan review (25 of permit fee)
I
Authorized signature: / Slate surcharge (12% of perm it fee) lc
�� { „ r� r M a _ r► TOTAL PERMIT FEE ,
Print name: 'MCP &.' Bate: I I Thit permit application expires if a permit n not obtained within lee days
after it has been accepted as complete.
I *Fee methodology set by Tri- County 1:luilJing InduIry Service Rnard.
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