Permit CITY OF TIGARD PLUMBING PERMIT
. ''' • g COMMUNITY DEVELOPMENT Permit #: PLM2013 -00050
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/13/2013
Parcel: 1 S135DB02900
Jurisdiction: Tigard
Site address: 11515 SW 91ST AVE
Project: Hampton Subdivision: CHARBEN Lot: 12
Project Description: Replace 45' of water service -
Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: HAMPTON, KENNETH B &
3300 NW 185TH AVE #213 KNOLL, LAURA D
PORTLAND, OR 97229 11515 SW 91ST AVE
TIGARD, OR 97223
PHONE: 503 - 533 -0430 PHONE:
FAX: 503 - 296 -2419
FEES
Quantity Description Date Amount
45 If Water Service 02/13/2013 $62.54
Specifics: 1 12% State Surcharge - 02/13/2013 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 02/13/2013 $9.96
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stones:
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: o, f ft_ fl /C � I � D
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.
To: Glty of Tl peg® 2 or 3 2013 -02 -12 20:35:44 (GMT) From: Oeorge Rlme,n may
C2 08 13;03:53PM;From:ProDrain & Rooter Srvc, To:5032962419 ;5035339376 # 1/ 2
Plumbing Permit Application
Site Utilities RECEIVED FOR oI'PICE USE ONLY
City of Tigard p Received le/ity d l 3 l 3 s( Permit No.: n(JA JO 13 �DQ
IlIl 13125 H Bv•, Tigard, OR
p l . Phone: 503.71 SW all k 2 Fox: 503' S98`i9� Plan Review c 2 3 D Other Permit No,:
T I G A R D Inspection Lino: 503430.4175 pale Ready /ny: J ® See Pone 2 tar
Internet: www,ligrd -or.g0v C ITY OF TIG , i i NotiliiedlMetltod: i Supplemental lornrmalion
....
..... r:Ir'[SE ":rSCIIED1JI.l!<
0 New construction ❑ Demolition Farspedal information use eneckliex
. Description I Q.Y. I Ea. I Total
la Addition /alteration/replacement ❑ Other. New 1- 2-family dwellings (includc5 100 iL Ibr each utility connection)
SFR (I) bath 312.70
RYA:OFt:CO1VS7'IRIL1GT1i0IYi''+ <:
(
.CA'P>EGO
® I- and 2-family dwelling ❑Commercial /in
dusttial SFR (2) bath - 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family - Faah additional badr/ltitchcn 25.02
D Master builder ❑Other: File sprinkler( . se- 8.) Paget
T N'QAM);l OCATIONsr' ' : Site utilities:
r !0 ....
Job site address: 11515 SW 91" Ave Catch basin or area drain 18.76
Drywall, leach line, or trench drain 18.76
City /StateJZIP: Tigard, OR 97223
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt no.: j Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no, l ncnr It.: � Page 2
• Storm sewer (no. linear (t.: _ ) Page 2
_ Water service (no. linear ft.: Pagc 2 62.54
Subdivision: I Lot no.: Fixture or Item:
Tax map /parcel no.: Beckliow preventer 31.27
Backwater valve
12.51
,,.D�SCRIPTiONi'4F:WOItIC`c : ,,,
Clothes wushtt 23.02
Replace water service Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ROPERT..y .OWNER`::: ::r:.zc:::r:; c 0'. l'iltNANT: • ':i :: '. ; .,:'` Expansion tank 12,51 ,
Name: Fixture/sower cup 25.02
- Floor drain/floor sink/hub 25.02
Addrertis: - Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ica maker 12.51 -
,. =::.❑ r;:APPY;ICAIV'f;?" ;;:: <: > •: ...ert4CONTACI`., IntercePtorigfcasc trap
Business name: Medical gus (value: $ _) Page 2
. - Primer 12,51 _
Contact name: - Roof drain (commercial) 12,51
Address; Sink/baslNlavatory 25,02
City /State/ZIP: Solar units (potable water) 62,54
Phone ( ) I Fax: : ( ) Tub/shower /shower pun 12.51
E-mail: Urinal 25.02
. . .. . - Water closet W ICr CIO OR
IVXRi► CP
C4
halter
otter
37.52
Business name: ProDrnin & Rooter Service Waterpiping/DWV 56.29
Address: 3300 NW 185th #213 Other; 25.02
City /State/ZIP: Portland, OR 97229 Subtotal 62.54
Phone: (503) 533 -0430 Fax: (503) 296 -2419 Minimum permit IOC: $72.50 72.50
CCB Lie.: 108504 Plumbing Lic. no.: 26 -776PB Plan mime (25% of permit fee)
g State surcharge (12% of permit foe) 8.70
Authorized signature: t V .. TOTAL PERMIT FEE 81.20
print game: Lisa Bakke , Date: 2/8/13 Thb permit ap esplrea if a permit Is not obtained within 180 days
after 0 has seen accepted ear complete.
*Pao methodology set by Tri- Couiily Building Industry Service Doard,
I ■Permit,lPLhiU•PeadtApp.doe ieieliOt .140.40ICAII1021COM/WSO)
To: Clty of Tlgara Page 1 of 3 2013 -02 -12 20:35:44 (GMT) From: George Rloen may
FAX COVER SHEET
TO City of Tigard
COMPANY City of Tigard
FAX NUMBER 15035981960
FROM George Risenmay
DATE 2013 -02 -12 20:35:29 GMT
RE
COVER MESSAGE
www.efax.cor