Permit •
•
CITY OF r AFZ � I` PLUMBING PERMIT
COMMUNITY DEVELOPMENT ` � Permit #: PLM2013 -00140
•
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2013
•
T t � A'' g Parcel: 2S114AB03600
Jurisdiction: Tigard
Site address: 16515 SW 93RD AVE
Project: Dowler Subdivision: KNEELAND ESTATES Lot: 23
Project Description: 40' of water service NOTE: Electrical permit may be required if replacement piping effects house grounding
5/8/13 REPRINT for correction to description work
Contractor: EXCELLENCE PLUMBING LLC Owner: DOWLER, HAROLD C & GAIL K
7520 SW 140TH AVE PO BOX 230301
BEAVERTON, OR 97008 TIGARD, OR 97281
PHONE: 503 - 643 -3459 PHONE:
FAX: 503 - 643 -2815
FEES
Quantity Description Date Amount
1 12% State Surcharge - 05/06/2013 $8.70
Specifics: Plumbing
10 ea Minimum Fee Adjustment - 05/06/2013 $9.96
Plumbing
Type of Use: SF 40 If Water Service 05/06/2013 $62.54
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. / o � �J
Issued By: t� �.L
(:f,/' Permittee Signature: U►�/} 'lj /" � ,D0 (C4 771/U
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.
III CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223 ii r J"
503.639.4171 7 &, i 3 .
TIGA
Receipt Number: 191253 - 05/06/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2013 -00140 Minimum Fee Adjustment - Plumbing 230 - 0000 -43101 $9.96
PLM2013 -00140 12% State Surcharge - Plumbing 100 - 0000 -24001 $8.70
PLM2013 -00140 Water Service 230 - 0000 -43101 $62.54
Total: $81.20
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 00772Z STREAT 05/06/2013 $81.20
Payor: Shelly Eugenio Excellence Plumbing LLC
Total Payments: $81.20
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00140
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2013
Parcel: 2S114AB03600
Jurisdiction: Tigard
Site address: 16515 SW 93RD AVE
Project: Dowler Subdivision: KNEELAND ESTATES Lot: 23
Project Description: 40' of storm sewer
Contractor: EXCELLENCE PLUMBING LLC Owner: DOWLER, HAROLD C & GAIL K
7520 SW 140TH AVE PO BOX 230301
BEAVERTON, OR 97008 TIGARD, OR 97281
PHONE: 503 - 643 -3459 PHONE:
FAX: 503 - 643 -2815
FEES
Quantity Description Date Amount
40 If Sewer Service 05/06/2013 $62.54
Specifics: 1 12% State Surcharge - 05/06/2013 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 05/06/2013 $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: . /4 // 1 � "' — ` ` ,�/ d/ Le ^ '- Permittee Signature: Q g /t / �n j � , I [ �7
6 , 1
,J ,/ ty/(.� ad
r'1'T F`�-/ /� ill
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.
05/06/2013 10:33 5036269149 POSTALANNEX PAGE 02/02
Piumbi_ rag Pe rmit Ap_ licati EivED
Site Utilities F(.11i twrlc•I: l SE 61N1,1
City f Tigard Received Permit Nn
ty MAY 0 6 201 Ontn2BY: S ( P 1 Jo/ 3_0010-0
1111111111 13125 SW Troll elvd., Tigard, OR 9722 Plan Review Other PermitNe,:
1 Phone: 503.718.2439 Fax: 503.59 11d 1Qi OFTIGARD .t nt.B :
T I G !`• R 17 inspection Line: 503.639.4175 1 1 1SION Ontc Ready/13y: t See Pane 2 Mr
Internet; www.ligard-or.gov y�B,{ DN Nrnitied/Methnd yyyµy *�} tcmcntnl 1nRrrmntion
t1 i(6j
?,ii 4 r � 15til�, I _ I 1 •: , . L :1: , IA/IY ,, I.lr
For eeinl In °rotaflon use checklist.
❑ New construction ❑ Demolition Descri. ion !II' Total
Addition/alteration /replacement C] Other: New 1- 2 -famil dwellin,s includes 100 ft. for each utili connection)
Ci i ittddie d1< : C : ' 1 Jt2 JJO ' : ! ; SFR (I) bath 312.70
`, °- SFR(2)bath NM 437.78
1 - and 2- family dwelling 0 Commercial /industrial
SFR (3) bath 500,32
❑ Accessory building r] Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other, Fin: sprinkler ( sq. iL) Page 2
c,_,.. t- . ;.;.,r. Sltrutilities:
>yb ` dd /651 ,.., 5 W -/ � - rd „ Catch basin or area drain 18.70
Job site a
— {� Drywcll, leach line, or trench drain 18,76
City /State/71.P: j , ,,,,,,,et / ' 7 22 / Footing drain (no, linear ft.: ) Page 2
Suite/bldg• /apt. no,: Project name: Manufactured home utilities 50.03
Cross Street /directions to job site: Manholes 11111•�
Rain drain connector
Sanitary sewer wer (n o. linear ft.: _) Ern
-° - storm sewer (no. linear ft: 1
T -- Water service (no. linear ft.: M
Subdivision: Lot no.: Fixture or item:
Tax map /parcel nn.: � preventer � �
Backwater valve 12.51 IN
r .I`:. _ . Clothes washer 25.02
— �.1�J_c , . ei"'vice Dishwasher 25.02
� ��` Drinking fountain 111.1�
Ejectors /sump 25.02
a , Expansion tank 12.51
(ital�'Yt'�'fi:'.bWl(I'��'•t.'-;::;:i.1:::.' : , : ; �'; i ' ... .
fr•, -;
Fixture /sewer cap 25.02
Name:
Floor drain/floor sink/huh 25.02
Address: Garbage disposal 25.02
City /State/ZIP: Hose bib
Phone: ( ) Fax: ( ) Ice maker
E;: "Ali"k't b ` `' .: -. F interceptor/grease trap 25.02
Medical gas (value: $ ) Page 2
Business name:
--- Primer III 12.51
Contact name;
.... Roof drain (commercial) 12.51
Address; _ Sink /asin/lavatory
City /State/ZIP: Solar unit (potable water) 62.54
Phone: ( ) Fax::( ) Tub /shower /shower pan 12 51 MOM
Urinal 25.02
' E -mail: ? ■ ' / e /.. Ar - A / 6hi . C � r Water closet 25.02
;.�r. 11cCu'�'I. . :'.` ... ... ... . . . 37 52 MIME
., . , _ Wa h ea t er � ..
Business name : = r ' / �^
lllF /� 4 Water piping /DWV 56.29
Address: 7.268 S/1/ C . � s b `, Other: 111MIEMIMIIII
City/State/ZW: Vet 9 700 g Subtotal MEE
Phone: 03) �1/3-3 � F ax: ( ) _—r--- at , y f r Minimum permii fee: $72.50 Wag
/ 75 /- F 7J -/ g p 9 � / Plan review (25% of permit Ibe)
OCR Lie.: [ p Plumbing Lic. no.; �
state surcharge (12% of permit fee) IIIE
Authoriind signature: _ :/, /7 ' ' . A' TOTAL PERMIT FEE r zo
Thin it perm application enpirtn if a permit is not obtained within 180 days
Print name: SAe �� ! / / Date: 5:043 a
-1' methodology ha t accepted complete. m Service Board.
by •�ntY 6 Industry
I:I Build ins\Ptrteltell 10/01/09 ona,1n-r IMt2ICOM/WiR)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16515 SW 93RD AVE, TIGARD, OR, 97224
Residential - Plumbing
330 Water service
05/07/2013 00:00
PLM2013-00140
PASS
NOTE Proof of electrical grounding provided.
Permit finaled
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16515 SW 93RD AVE, TIGARD, OR, 97224
Residential - Plumbing
330 Water service
05/07/2013 00:00
PLM2013-00140
PASS
NOTE Proof of electrical grounding provided.
Permit finaled
Violation Summary:
Inspector Contractor