Permit (13) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00283
T[iA fz„D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/6/2023
.3
Parcel: 1 S133DD 11300
Jurisdiction: Tigard
Site address: 11879 SW 125TH CT
Project: Eric Mercer Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 150
Project Description: Replacing 30 ft.of kitchen,laundry and interior sewer line inside of crawl space and water piping.
Contractor: JACK HOWK PLUMBING/RESCUE ROOTER Owner: MERCER, ERIC ALLEN &JANINE M
PO BOX 2830 11879 SW 125TH CT
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503-850-3100 PHONE:
FAX: 503-491-2932
FEES
Quantity Description Date Amount
30 If Sanitary Sewer 07/06/2023 $62.54
Specifics: 1 ea Water Piping/DWV 07/06/2023 $56.29
1 12%State Surcharge- 07/06/2023 $14.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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
Issued By: Permittae Signature:
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 Permit Application
Building Fixtures �j ` FOR OFFICE USE ONLY
City of Tigard ReceivCEIVED DateBy� / r�/7� �� Pernul No.: /f� Ad �jt L!� ti
■ 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review / V vt y
ill _ Phone: 503.718.2439 Fax: 503.598. 9 DateBy !S Other Permit No.: ¢� 0,4 -
9 7
Inspection Line: 503.639.4175 ��� Date Ready/By: •�Juris?• 0 See Page 2 for
TIGARD Internet: www.tigard-or.gov JUL t 6 Notified/Method: -' 7 Supplemental Information
TYPE OF WORK OF� TIGARD FEE* SCHEDULE
❑New construction ElD p Div For special information use checklist.
• IIVO Description I Qty. I Ea. I Total
®Additionialteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
,�J/' CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-family dwelling CICommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I I '1 01 lice " Catch basin or area drain 18.76
ty / � 2 Drywell,leach line,or trench drain 18.76
City/State/ZIP: !lJJ�`//_ //////��_//JJ��
i A Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.. ` I Project name: M/' lI i//� Manufactured home utilities 50.03
Cross street/directions to job site: t t�/y V Manholes 18.76
Rain drain connector 18.76 II nn
Sanitary sewer(no.linear ft.:1M l Page 2 4402 2 ,S '
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
( Clothes washer 25.02
In ( t U/lJ1 IlN Dishwasher 25.02
t ''/�t L/IIof 0 e5 ,�/ I I Ile
lJ Drinking fountain 25.02
At
t f"vtn Jr of--I-1/1 O_ t 1 / l-5f�� , Ejectors/sump 25.02
PROPERTY OWNER �/Y IA�� TENANT Expansion tank 12.51
,3141 r,
Name: `/i r� Q ( ti Fixture/sewer cap 25.02
I Floor drain/floor sink/hub 25.02
Address:
�n ��II Garbage disposal 25.02
City/State/ZI( 1 __ v1 12j Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
21
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:PirAkyi e. O' 'a ,a -stru co- (-(� Medical gas(value:$_) Page 2
/ Primer 12.51
Contact name: faCi Roof drain(commercial) 12.51
Address: �67.g.., $'0 Sink/basin/lavatory 25.02
City/State/ZIP: Q aa-6V--q,7 O+G- Solar units(potable water) 62.54
Phone:(450# Z 0- )I V D Fax::( ) Tub/shower/shower pan 12.51
E-mail /� a /nj R �f6_ (1 Urinal 25.02
`� D l �.✓ '�"r `d e l Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: /f/� ry q.,c ry Spiv / ' n
� yirCa IVf Q 4/"t � l3[L/� �'-�/ Water piping DWV ' 56.29�Cj�.2 I
Address: 1 'V Q Other: 25.02
City/State/ZIP: I I ` t $ M9--q/O 15 Subtotal4e"d-' !
Phone:("a , sco , 3I DO Fax:( ) Minimum permit fee: $72.50
/ ,I
CCB Lic.: J} Plu bing Lic.no.: I p g
/ Plan review (25%of permit fee)State surcharge(12%of permit fee) 4+ ate
Authorized signature: j1 f60 TOTAL PERMIT FEE, ' O
Print name: Date: /L( ,6 This permit application expires if a permit is not obtained within 180 MI5's
/ i,J after it has been accepted as complete.
�-- a *Fee methodology set by Tri-County Building Industry Service Board.
IiJBuilding\PerunislPLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)