Permit (/ PLUMBING PERMIT
4
CITY OF TIGARD
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COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00516
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/19/2007
PARCEL: 25111 DC -10000
SITE ADDRESS: 15650 SW OAKHILL LN ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.10 LOT: 557 JURISDICTION: TIG
PROJECT: BAKER
Project Description: Water heater replace.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: •
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SALLY BAKER
15650 SW OAKHILL LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 11/19/2007 $72.50
[TAX] 8% State Surcha 11/19/2007 $5.80
Phone : Total $78.30
Contractor:
A 1 INSTALLATIONS LLC
8116 SW DURHAM RD
TIGARD, OR 97224 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 620 -5657
Reg #: LIC 150109
PLM 34 -386PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
f 1 •
Issued By: AA J, j �f Permittee Sign ature: :�
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.
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Plumbing Permit Applica � LLtt . • -- CE‘VtU I ol; Ol'l'I( I •: t til::. ONL1
City of Tigard Received •
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1 a 701;1 ,,,,,,, 1 u - 0 , v permit No. V 2.A • -
,- . 13125 SW st ill Blvd„ Tigard OR 971143N a. elm Review
Phone; 503.639.4171 Fax: 503.598.1. Iii, Date/By: Other Perini No.:
Inspection Line: 501639.4175 , ®� d (�
1 1 " is . 1 7 p Read /d .
Intarnet' www.tigard.or.gov : a %it U 1uu`' ' Dpihed/Mettl: S for
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�•.� -IL'� -11 1'AJ
❑ New cnnctnrrtinn :.,.., . " ;'; :,''t:.:", ':r.: ..c..,
❑ Demolition
Fn r.e v i nformat i on Jai! checklist
Z 1 Addition/alteration/replacement Qty. I Ea. Total
.. .... wel
,., . . . !:il.,. , . y � (includes
100 ft. for e utility connection)
eP aceme Other ,,.. •.�.`t:;iii�41,;.:! I • . , � "i'.: .,. ' R (t) bath 24920
,Q] I- and 2- family dwelling ❑ Commercial/industrial ; ; SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
❑Master builder Each additional bath/kitchen 45.00
❑ O ther:
S B;
9 fL) 2
. '...lR........ ,... ,>l~i7�agE',rsilv�� "�, u
;, : : ` ,: • site utilities
Job site address; L5 4, £ 1 C. 1,I dl , Catch basin or urea drain 16.60
City / State/ZIP: ,cia1ra 9 7 1 ti Drywall. leach line, or tn drain , 16.60
Suite/bldg /apt, no.: J I Project name: e kadt_ Footing drain (no linear ft; _) Page 2
Manufactured home utilities 110.00
Cross street/directions to iob site: -
Manholes 16.60
_Rain drain connector 16.60
Sanitary sewer (nu. Iivau ft.: ,J Page 2
Storm sewer (no. linear ft-: 1 Page 2
Subdivision: l Lot no.: Water service (no. linear ft.: 1 Pape 2
Tax map /parcel no.: Fixture or item
P �: ;::,.., .•.d,.l'. -,.. ,. -�,., ;r •. • Absorption valve 16.60
. . ,.:,. .D �' I' g.:'*. };':, ; :
.... � �5?�;;;:Q.•.......,A�C'', .:. •:�1- .: tfackflow prevt:ntcr Page 2
R
m t-ek_ k& Backwater valve 16.60
(9ruhes washer -
16 -60
Dishwasher 16.60
, '•: ",•.. , .G , ..Ir,.,;r., :x :G: ::.i,A :• ��• founta
-
Na ►ne: " Eioctors/ 6.
`Q_, - Expansion tank 16.60
Address: f _
- w ry j L Fixture/sewer cap 16.60
City / State/ZIP: 1 1 0 e. 9 "1?�
g V Floor drain/floor sink/hub 16.60
Phone: (_91•3) 46"�. Fax: ( Garbage disposal
7 , r . r
...
�` ... FL>l(P' . ':I11 ._J,, ^ 5.(!01►1T ( !� ASQ11F: OSC ib 16,60
Business mime: �1 //4.A/04., I maker 16.60
� ', ✓S � „5_ interceptor /grease trap 16.60
Contact name: E C 1 Medical gas (value: $ ) Page 2
Address:
Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax :: ( ) Sink/basin/lavatory 16.60
E-mail: Tub /shower /shower pan 16.60
r L eb
• .: ;:..'..., � ....... urinal
1��13 r.: ,:
. .�+ 16.60
_...._ .... :'.;.: %;:.•,::'.: ::- ::�:..... ° ` Water closet
Business name; A i ,s M 4 -f lan S Water heater ' 16.60 /t rte
Address; $ LI ( Sw (D... 44 vs-t it 4, Other:
City / State/ZIP: Tl. - al r a Subtotal
Phone: (R8) 6 Fax: Minimum permit fee: $72.50 -7?
) 4 . I ti 7 Residential tineklluw minimum permit fee; $36.25
CCB Lic.: Soap' r . -0, Plumbing Lic. no.: el.- 94 p 2 Plan review (25% of permit fee)
Authorized signature: / State stuchargt (8% of permit fee)
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TOTAL PERMIT FEE 79
Print name:
I�l c.. Srr� / f 1, Date: j . `j /j2 • This permit application expires If a permit is not obtained within
/
180 days after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
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