Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00354
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2013
Parcel: 2S112CB03900
Jurisdiction: Tigard
Site address: 8469 SW ASHFORD ST
Project: Woodard Subdivision: ASHFORD OAKS NO.2 Lot: 53
Project Description: Replace 50'of water service.
Contractor: 3 MOUNTAINS PLUMBING Owner: WOODARD, DANA C&BEVERLY A
524 N TILLAMOOK ST 8469 SW ASHFORD ST
PORTLAND, OR 97227 TIGARD, OR 97224
PHONE: 503-670-1342 PHONE:
FAX: 503-828-0515
FEES
Quantity Description Date Amount
50 If Water Service 10/10/2013 $62.54
Specifics: 1 12%State Surcharge- 10/10/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/10/2013 $9.96
Plumbing
Class of Work: OTR
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: D ` �4)G1el/Y—n0A/
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.
From:Bill Kerrigan Fax:(503)765-5512 To: Fax: +1 (503)598-1960 Page 2 of 2 10/8/2013 4:28 .
Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
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City of Tigard \� , ,,,,,II, /A /d i
n 13125 SW Hall Blvd,Tigard,OR ''t? st I'IaII Itesg„
i a Phone: 503.718 2439 hax: :4.114. I % n;,lcls 1 (pliei Prima NO
Inspcenon line- 501.09 4175 (`� �)tnc Read1 It, �P 1//�r ® err rnKr?G,r I
TIGARD Internet: wuu tigard-ur.go% C 1�J,w`1;10 ',untied maw 11�(ID .uVPlrn'rinal Infurma tit,n
TYPE OF WORK OV �4 3 '\ i F'F:E` SCHEDULE
❑O `G tine xpr'cial iaJurmuliun use checklist
❑New construction ` tv. I.a. total
Ik,alpuun l?.
3/Addition/alteration/replacement Ulh+�� \r%I-?-r iuil)daellin Include,11)0 II,for cacti intim connection)
❑ � K'I
31
l
h
I) all 312 72
CATEGORY OF CONSTNII ION SIR■, r
NI•R I-r hall 437.78
y
311-and 2-Tamil dwelling I:Commercial/industrial I -
I - -, 51Rt31hail, 50912
❑Accessory building ❑Multi-lanul) I '_5 22
` I_ach additional bath/kitchen {
❑Master builder ❑Other: I Ire,pi nkler l_+4 11.1 { Page 2
.IOB SITE INFORMATION AND LOCATION I ; Site utililir,:
ucb h;um or arell dram 15.75
Job site address: $1ftq S W As►I(=oi'_,7 ST l
I Un\,ell,leach line,or trench drain 15.75
City/State/ZIP: 1 Gr„zT, b q-,
Houng drain(no linear II _) Page 2
Suite/bldg./apt.no.: 1 Project name: I Manufactured how utihtic, 5u.U3
~-- R.75
Cross street/directions to job site: Manhole; 1
�• I (lain drain connector i 1 IS 71,
Cz OF SO �hlro2D ST Fir• r5�J HRt._ gt,v7 Sarnia),rucr(no.Ilse:u I1 ,) i Page 2
i
Mona seer per.linear 11.' ) Page 2
1
1 Nutter service(no lute;u 11: 56) / Page 2 i„,9. 1.4
r
Subdivision: Lot nu. Ir i%turr ur item:
iiaekllu\\pre\enler 31.27
Tax map/parcel arcel no.: r
IIF I liaeka
\ kr,tihe 12 it
DESCRIPTION OF WORK Clothes\,a,he1 { 25.02
1--
F
oitlrJ4, NEN 1,14TCP 5v'icc. I)I,hma,her 25.022
lJnnkum!I;nuu 1 2Gu2 am
I I eclur,i,untp 25.112
r
D4ROPERTY OWNER 1 ❑ TENANT 1 I..\pan,wn talk i I 12 51
{ l ux1WCi,ener cap 25-U2
Name:� I l`
!),,,A, WCPAAIZ7 I kW Jlam;lluw;utkrl,,)1) 25112
I
1 I
Address: 8,461 .20 5 T lrarhal_e disposal 225.92
1 I
City/Slate/LIP: I upee, Lam? g7dd`i I lose huh
25,1)2
I i.
Phone:( ) fax:( 1 1 Ice maker I 12.51
APPLICANT 12 t:ONTACI' PERSON Interecptur;prc:se trap 2`11'-
-
~.b1eJlrall a,?value Sr I I':Igc 2
Business name: 1
-� �Vr"'eiM/,IS pLL'r'�13ilJ Jo 1't liner 12.51
Contact name: 11 { I
l..wt"zr,..) G¢L6r" k_K,wl drain Ieuuunelclal) I - 12.51
Address: sat' 0 --r,L444b0e. sr_ timkih:uuulasItun 111 25.u2
City/State/ZIP: uz..,_r-414> Up y7a•- f I Nu/a1 snits(putahle_uater) 52 34
111hnho\,crr,lW\\er pan
12.51
Phone:(Se%) (070 i3e,la Fax::1 1 -1 •
I L nnal j I
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F-nail: it. i ?�1Yorl�crnS7iJM?nC�[yrrl N Icr ew;et 25,02
CONTRACTOR
I \ham nettle? 37 52
t I
Business lame: 3 ptocN cil,/n Address: .,s-,9,1 t1+MOJL S S�T u MTi1NC� I
N Eller plpine/)WV
)thee 56.29
25.92
tiublulal (0 ,S'1
City/State/ZIP:MA,r`�N Ce. �!_709:1
Minimum permit Ice 572 50
Phone:( )i !0 l-ax:I I
-
5D� /3'1� i Pl,ltl revlcu (25%ui panful lee I
Ir CCB Lie.: it,94/y7 Plumbing I.ic.no. ` I rou(pernul lerl
O p e] • ',taw surcharge l n„
Authorized signature: 1 13 1 AL 11LRMI I 1 1 r
I
I hi.Irrnw application a\prre,if a nrm ll n nut oblauly
d within ISU Jny,
Print name: L41, I)ale /0/).,./s
I �C� e,zEN alter ii ha,been nreepred a%rumples.
-I-cc nlahoduloeu'.•I t, I ri.i,„gut,14uadinp hrJlnln Service Board
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