Permit ■4
n CITY OF TIGAR® PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2009-00348
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/10/2009
Parcel: 1 S133DA04800
Jurisdiction: Tigard
Site address: 12630 SW GLACIER LILY CIR
Subdivision: Lot: 0
Project: Koepke
Project Description: Replace (2) lavs, (2) tub/showers, and (1) w/c.
Owner: FEES
KOEPKE, BRUCE Quantity Description Date Amount
12630 SW GLACIER LILY CIR
TIGARD, OR 97223 2 ea Lavatories 12/10/2009 $50.04
PHONE: 2 ea Tub/Shower/Shower Pan 12/10/2009 $25.02
1 ea Water Closet 12/10/2009 $25.02
1 12% State Surcharge - 12/10/2009 $12.01
Contractor: Plumbing
BUDS PLUMBING LLC
PO BOX 821809
VANCOUVER, WA 98682
PHONE: 503-577-4200
FAX: 509-628-1550
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 952-001-0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: \ J 'U LA LI~ n I I /)n9. Permittee Signature:
=d Call 5A033.639..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.
'Dec 09 2009 18:32 VINTAGE OAK FAX 360 546 2036 P.1
A
Plumbing Permit AIRplicllfiO JED
, affi- Building Fixtures a~ 7 M:
DEC 10 2009 a ~ -
City of Tigard Received Permit NoPL
0 13125 SW Hall Blvd., Tigard, OR 97223 Dar. Review
Y s Phone: $03.639.4171 Fax: 503.{D OFTIGARD D, Byr Other Permit No.:
Inspection line: 503.639.4175 BUILDING DIVISION Date Ready/By: ®See Page 2 for
Internet: www.tigard-or.gov Notified/Mcthad: Su lementallufarmation
t .l , t~ l ei i g- %F' li J~'I 3. , ~ "3,2~ is "o
❑ New Construction _ ❑ Demolition For special in ormafion use checklist:
Description Ea. 'T'otal
Additionlalteration/replacement ❑ Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
SFR (1) bath 312.70
SFR (2) bath 437.78
1- and 2-family dwelling ❑ Commercial/industrial
SFR (3) bath 500.32
❑ Accessory building ❑ Multi-family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler sq. ft.) Paget
Site utilities:
Job site address: a lD G la Gt 1r L. ' ` ' V(, t Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/Statc2IP:
Footing drain (no. Linear ft:: Page 2
Suite/btdg.lapt, no.: Project name: Yoe Manufactured home utilities 50.03
Cross street/directions tojob site: Manholes 1976
Rain drain connector 18.76
Sanitary scvver (no. linear fL Page 2
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
a q IaBackwater valve 12.51
Ft r- t ti Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
` Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
N, 1~
11 NFAM-1, 1, si31' I( Interccptorlgreasc trap 25.02
1 F 1. , 41
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Rouf drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/Z[P: Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Inv, t • Water closet 25.02
n ' i ~'1 Yt Water heater
' 37.52
Business name: S y~,k I Water piping/DWV 56.29
Address: r O ♦ IL Other: 25 02
Pi srate/zlp: 0.1A t t? V e r Subtotal
Phone: Fax: ( j Minimum permit fee: $72.50
CCB Lie.: &N Plumbing Lic. no.: .S Plan review (25%of permit fee)
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE 2 . 09
Print name: ~ps t1 yMN S Date' -091 This permit application expires if a permit 1, not obtained with n 180 days
after it has been accepted as complete.
'Fee methodology set by TriCounty Building Industry Sttvice Board.
I,1IIuildinglPerrnis'PLMU•PamrtAppdec 1001109 440_4616t(IOIp21COiN1WEB)
A