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Permit a CITY OF TIGARD PLUMBING PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00055 T i G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2013 Parcel: 1S125DA06500 Jurisdiction: Tigard Site address: 9600 SW 69TH AVE Project: Adkins Subdivision: KINGS VIEW Lot: 51 Project Description: (1) storm sewer 100 linear ft Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: ADKINS, NORMAN J 3300 NW 185TH AVE #213 9600 SW 69TH AVE PORTLAND, OR 97229 TIGARD, OR 97223 PHONE: 503 - 533 -0430 PHONE: FAX: 503 - 296 -2419 FEES Quantity Description Date Amount 100 If Storm and Rain Drain 02/14/2013 $62.54 Specifics: 1 12% State Surcharge - 02/14/2013 $8.70 Plumbing 10 ea Minimum Fee Adjustment - 02/14/2013 $9.96 Type of Use COM 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: J11.1 Permittee Signature: /1 PPU C A—Mk 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 'elr>te • nit A li® ETVED Site Utilities FOR OFFICE USE ONLY City of Tigard -- 1 4 2013 Dat Door .z/14 / 3 c..4 Permit No.: p ( aDl -O S, 13 t Phone: SW Hall Blvd., Tigard, OR 97223 lean Review Other Permit 1 f%I Jo 13 - A)C O )- 0 Inspection line: S 3 75 TIGARD Ma Reedy/Br ,, ( ® Pie 2 for T ' U ^ � " Internet•.. w.tigard- Notirmamlea>o� 'JIW �sd,prdraaentot don TYPE OF WORK FEE' SCHEDULE Now construction ❑Demolition For special information useeheekllit 0 Description 1 Qty. I E.a, I Total Addition/altcnition/repktcement Q Other. New 1- 2-family dwellings (includes 100 It for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 _ 'and 2- family dwelling ❑ Commereiallindustrial SFR (2) bath 350.00 1:1 Accessary building ❑ Multi - family SFR (3) bath 399.00 . Each additional bed/kitchen 45.00 ❑Master builder ©Other: Fire sprinkler ( sq. I) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: CliCip irh- _ Catch basin or area drain 16.60 City/Stat /ZIP• f 1 o ( d r ne 7 Drywall, Icach tine. or stench drain 16.60 Suite/bldg./opt no.: ,j ` Project name: Footing drain (no. linear ft.: !„) Page 2 ■ - Monu &ctmed home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Ruin drain ammeter eter 16.60 Sanitary sewer (no. linear It: _) Page 2 storm sewer (no. linmr R' AD l Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: •_) Page 2 Fixture or Item Tax map /panel no: Absorption valve 16.60 DESCRIPTION OF WORK Baekfowpreventer - Pagc2 _ 17f e , .t∎ In P sr _.) r eta .._ ,, u Backwater valve 16.60 .- f\ . • . IA - n r fa ' • • M� i Clothes washer 16.60 IPA ■ �) u Dishwasher 16.60 r • - ' ' "' Druddog fountain 16.60 ❑ PROPERTY OWNER ❑ TENANT - -- -. Ejectors/sump 16.60 Name: 'Expansion tank 16.60 Addre= Fixtuic/scwercap - 16.60 City/State/ZIP: Floor dmiNtloor sink/hub .16.60 Phone: ( ) I Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON lion bib 16.60 ix maker 16.60 Busing name: Interceptor/ grease trap 16.60 • Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Phone ( ) I Fax : ( ) Sig/basin/lavatory 16.60 Tub/shower /shower pan 16.60 E-mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name ' tk D Ob1/4 e - SF,(241r t z Water heater 16.60 Address: -3tx) u) , CY 6 4- A- *7_4 5 Other: . City/StatrlZ[P:. o(A A �c1 ( rZ e . -7 j �' - Gi �, Subtotal t ' "� � - ( f Minimum permit fee: $72,S0 Phony (5 ) 7 to - C r7 0.3 Fax: _ - 2-+f 1 Residential baddlow minimum permit fee: $36.25 CCBLie.: l b gl��� Plumb - .: . :( 0 `776,?_13, Plan review (25% of permit the) Authorized SignatW e• , State surcharge (12 %of permit fee) (Q�t. � TOTAL PERMIT FEE - V70 - Print nrenc: l al ' xp 4 1 ' 1 1 t ` Date: 2 ^ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. `Fee methodology sct by Tri- County Building industry Service Board l /l #- 9L£6££9£05• 61tZ96Z£03:o1 'oAa9 aaloolj)i u!eJOoad:woad'WdZ9:l0'£l -171. -ZO .tow uOblTJ o6�oo�,:wo�� .- (1W.) 4 6S:OL vL -ZO' I-OZ ' L t o I. o6o P..o611 sic■ As17 :ol pn, < F 7.777.7r ,..,......... - rp: Porrnit 6. rtr".r.t 1- .7 g 7.. 4 .. , ......, .......-....- •-- - Fr .-.:-.---:-.:.•-•••::'• •-•-•.-.....--:-.-:•-•::: : : : :----;•.::- : -•• ; •:. .' :' ..: 2-•- . ::: : : . • • • -:'...'::: - ;•:.- • :-:: - ::'-":.:: - ;:- . - - -'..- . - s ' '''-::.•••.'-::::::'. 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