Permit aka CITY OF TIGARD PLUMBING PERMIT
a >: COMMUNITY DEVELOPMENT Permit #: PLM2010 -00077
T(GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/17/2010
Parcel: 2S104AB06300
Jurisdiction: Tigard
Site address: 12162 SW 131ST AVE
Subdivision: MORNING HILL NO. 4 Lot: 92
Project: Roast
Project Description: Replace gas w /h.
Owner: FEES
ROAST REVOC TRUST Quantity Description Date Amount
12162 SW 131ST AVE
TIGARD, OR 97223 1 ea Water Heater 03/17/2010 $37.52
PHONE: 1 12% State Surcharge - 03/17/2010 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 03/17/2010 $34.98
Plumbing
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
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 -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: C.(....44\ l�l k YA.(1 Permittee Signature: Ayp
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.
Plumbing Per it it Application
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� ti�" a 13125 S W Hall Blvd., Tigard, OR 97223 L Plan Review
0 I Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
d inspection Line: 503.639.4175 CITY OF TIGARD
T IC'A DI Date Ready/By: H See Page 2 for
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°;a, Internet: www.tigard- or.gov BUILDING DIV [ Notified/Method: I r Supplemental Information
TYPE OF WORK FEE* SC
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
® Addition/alteratio replacement) ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
j Job site address: 12162 SW 131 Avenue Catch basin or area drain 18.76
City/State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: SW Katherine St. Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Morning Hill 4 I Lot no.: 92 Fixture or item:
Tax map /parcel no.: 1 S104AB06300 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer . 25.02
Replace gas water heater
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Brad Roast
Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12162 SW 131 Avenue
Garbage disposal 25.02
City/State /Z[P: Tigard, OR 97223 Hose bib 25.02
Phone: (503)590 -3314 Fax: ( ) Ice maker 12.51
❑ APPLICANT - - ❑ CONTACT PERSON - Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer . 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
- Water heater 1 37.52
Business name: Owner Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 72.50
Plan review (25% of permit fee)
CCB Lic.: ' umbing Lic o.: State surcharge (12% of permit fee) 8.70
Authorized signa •�� TOTAL PERMIT FEE 81.20
Print name: Brad Roast Date: -43' _./
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.