Permit r \t .t . , CITY OF TIGARD PLUMBING PERMIT
•
• A- COMMUNITY DEVELOPMENT Permit #: PLM2009 -00214
- 1 ., 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/06/2009
Parcel: 1S133AD03800
Jurisdiction: Tigard
Site address: 12750 SW SPRINGWOOD DR
Subdivision: Lot: 0
Project: Mitchell
Project Description: Install tub and valve.
Owner: } FEES
MITCHELL, JOHN EDWARD AND Quantity Description Date Amount
KAREN KAY, 12750 SW SPRINGWOOD DR
TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 08/07/2009 $16.60
1 12% State Surcharge - 08/07/2009 $8.70
PHONE: Plumbing
56 ea Minimum Fee Adjustment - 08/07/2009 $55.90
Contractor: Plumbing
RD PLUMBING
13900 NW SPRINGVILLE RD
PORTLAND, OR 97229
PHONE: 503 - 297 -7422
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 B . ( \ Permittee Signature:
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.
. t irk
Plumbing Permit Application RECEIVED
(",,, fkK ., _ . -'`; 1 1� 7,_; r , t , v y .?, i �' r 7 v).�1 v t .
Building Fixtures AL'G 0 5 20 e�, k i � '.s4 ` g -- + f 3 ,)Ft u ( � ,,. y ( )NI 1 rt } Ir 1 -^ t {t
? i '?tN City Of Tigard ' Rec;i r
,, e { , t'etoiit No.: // t / 6 . QQ) I ` ._ t _ "
ii, w 13125 SW Hall Blvd„ Tigard, OR 97223 CITY OF TIGA O. Review - ..
. I. ; a ?hone: - 503.639.4) 71 Fax: 5(13.598.1960 BUILDING DIVI • a.1.. nm
Other Pei No :
�yx
-:+, G :*1. Inspection Line: 503.639.4175 Date y Read /li o' 0 Sec Pagc •2 for
GI RD
��a�;� 1A Internet: www,'p�.p(t��igard- ur.govdV ✓;��5 ,! 1 �y •'4if4'/1 Notified/Method: At Supplement' f fnfurma -
t' .11(5 i S. kci ttifl 4iLY RI'' }hill( ryi n . u :�L7 rM '. a nt ' iii l� v 4v'' ){ ) N �Aj' t�l ".)'')):,1'4'1'1"1.‘
1F "' ED FIE.' .. .. -
1 �. LU '�Nei 4 .N{ .l rl.�.x.1�.. _i... .
111 Ncw construction ❑ Demolition
For special _ information use cGcC' 1st
... - Uesctptiun OR, 1 I F :a. f Total
' • ddttion /alteratit n/replacement ❑ Other: New 1 2-family dwellings (includes 100 ft. for Cat utility connection)
1 X1 { ! ltgt t 1 ' � i, f„ x , tl l { ti q 0 , I del ■ I C` 'g4 p lli � at ll l rn('�'
. i S 1 bath 2
4J..v �'l�I.. '�\ " i i gyp"' IJ' hLl l.lt 4l fwl' �141![f�,lE k ` a I I u_r� 1 v d f)1 ( ) ....
s.1: and 2 -famil y dwelling SFR (2) bath j50.00
g
❑ Accessory building ❑ Multi-fumily - SFR (3) bath . }vv.00
j r'�!f' r � II '��16111,1Q-".,111 -• Each additional bath/kitchen 145.00
ci p9tl:W�1lmW L•l1t 9�im -- -..... ... - -.
Master builder ❑ Other:
1 i i I u t fI Ht! at 1 4,a.+y* l''''' 3t'i d� I q" v;n Fire sprinkler ( 5O. ft.) Wage 2 .__.
�17 4i ,i' i(1 f Sl?t�' ' gyp,' P � I� � G . ! q,.x? rM flJ Q, ° f r� �,�',!" 1 1 1 r/ $ .
Job s . i
l h11� , 1 ;.)lLa,', y ..lr lehSb, r. b! (�,' �'R9 �l� Site utilities
itc address:/„2 7 S`0 St,...) pr' ✓ LJn � i b r - Catch basin or area drain 16.60
City /State /ZIP: /1111..10 .77 lirywetl, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: Project name: Footing drain (nu. linear fl.: _ ) Page 2
- Manufactured home utilities I I 10 00
Cross strcct/direetions to job site:
__ ,. - . ___ Manholes 1 16.6))
�__ Rain drain connector 1 1 (r.6U
Sanitary sewer (no. linear fl.: _) °arc 2
Storm sewer (no. linear ft.: _ ) age 2
Subdivision: Lot no : Water service (no. linear fl ) age 2
._....._. -- .. ...... . Fixture or item
Tax map /parcel no.:
i l ! pit �1 `9JAi �1�1112; ` '4pVyrl� �)fl�,I{I)1l I I,I Y ' t l' , I 3 t J t l ilT( p ti Ii r n 1 I, ynr'.y. _,:,
Ah30Tpt10n valve 16.60 __ -..._.
i d
i.ki,:1;7 omol lll'I) l ' . ,itivowc ,,1, 1' tl l a , I ; l j dw:i µ o,. " i , t � 4x 1 ',11,w;4'
, u)i∎ 1, "' tl� ) ,,T. „ 2
�a,i�,: 4 ,ry o A✓ o , t , '8 v , "y !�'u
n l il BACkflOW pt'eVelller aCC
5 .7-,( L. 4.. Ug/v�, Backwater valve l 6.60 1
Ha j
Clothes washer 16,60
-
1)ishwashcr 16.60
. i. I fl i , ,„� ! ItL' i 1 ` I Lit, ') . t 1d1 1 fir G.' ,- '1)� Drinking fountain 16.60
'', , X1 1,, tIf'�E 1 }F ' � Ber� �a 't �L
�x
L• ector� /sent 1 16.60
J P
_ _ . . E x p a n s i o n tank 16.60
Address: Fixture/sewer cap 16.611
City /State /ZIP: Floor drain /tloor sink/hub 16.60 -
Phone: ( )
Fax: ( ) Garbage disposal - 16.60
,''( l :r ++ i''i + t' i 7i
ll T 16
� 1 , �,'t.il t v ! s. .,w", 1 �*� r�n, l . ho bib 16.60 • li
''.- $ •fv1 � 11,4 'Adak I F . 4 4.':. I !•':•41 7,li 5:65 l 1 111 % 'les.; •1'9 e.c it : ; l4 . :- lee • p Ice maker 16.60
Business name: F 1) "' LAW7
1 vl Yt Interceptor /grease trap 16.60
me: --
Contact na ) age 2
a�n,. - � �j�y � Medical gas (value: $ ) a
Address: Pru 1 6.60
13 800 ri� 1;. fill
City /State /ZIP: f,-)1A o1.- 9 72.2 Roof drain (commercial) 16.60 1
Phone: ( 3 ) .297 -2 if _ Fax:: ( -4 3) c2-!) 7 j /'J Sink/basin /lavatory 16.60
Tub /shower /shower pan - _ 1 l 16.60 / to Q
E Urinal 16.60
hi i u R1rvA o-fli rm •! [iy .I! 1 3 �;p��1JI � y � �Il I q li e ri "F°'1 i') � !e �l 1 N{ I+
1;".','; { ), ; ' 0 • tl i ��{°• : , I t; l; 1 .� I Ii r i; . �,t l firvur ONI it ! Y1t il11N
111 0 r.1v �'v' :! I i . t { y] Y lY;
, IAi): 'Ver , I)V aI � 1 NI:d l01 w4 �� iq;,,,rp eel- 11 M l +.l.�i I ww...h ,,r,,%d�� v tflDdui 11 � 1 �,,,; Water c'oct 16.60
Rosiness name; (c tfrk1o• j J ,C Water heater 16.60
f _ .... ......... Other:
Address: 13 60 ' c,J 5p ' 0 -II r K-� __..._. _.. _
City/State/LIP: Are% 7
Subtotal /� -
Minimum permit fcc: 72.50
Phone, (S7,3) 2 '7 7 1 4 Fax (i3) ��' 3(/ / Residential hacltlow minimum permit fee: 7
3f .25 a . 5r'
C'C' Plan review (25% of perrul fee)
B L1c.: 4/ Plumbing Ltc. no.: ,X-3/3
State surcharge (12% of pun it fcc)
Authorized signature: l
�" �.- ..• -- - TOTAL PERMIT FEE b�•14J
Print name: 7L4, TGb %.(\ a - I Date: p = s Thls permit application expires If a permit is nut obtained within
180 days after it has been accepted as ' ornplrle.
*Fee methodology set by'I'ri- County Building Inds illy Service Hoard
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