Permit CITY OF TIGARD
PERMIT
� ' ..; a COMMUNITY DEVELOPMENT Permit*: PLM2010 -00084
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/19/2010
Parcel: 2S 103ACO3700
Jurisdiction: Tigard
Site address: 12532 SW 114TH TER
Subdivision: WALNUT GROVE Lot: 6
Project: Borok
Project Description: Install shower jet.
Owner: FEES
BOROK, JULIE Quantity Description Date Amount
12532 SW 114TH TERRACE
TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 03/19/2010 $12.51
PHONE: 1 12% State Surcharge - 03/19/2010 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 03/19/2010 $59.99
Contractor: Plumbing
MP PLUMBING CO
PO BOX 393
CLACKAMAS, OR 97015
PHONE: 503 - 655 -9161
FAX: 503 - 655 -1726
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: ∎I� Permittee Signature: I
g / 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 Permit Application' ` ; ,
Building Fixtures '. -- ` : 1 (41 .,i + )i :,l � l t 1 . \ ' 0 * - t 44
MAR 19 20 1 3 g , = r '.'-re. V ia� � n % ate
h City of Tigard n� �n a4 / /7/' /0 4 'et/OL}
' . 13125 Sw Flail Blvd., Tigard, OR 97223 I"I y ni` I 1 E /Ai.' i L)) Plan Review Phone: 503.639.4171 Fax: 503.598.1960 + '. Other fermi No,:
or
. .: & o ti I!� - ( ic:�-- _ ` A Ik ,le /By:
Z �; a Inspection Line: 503.639.4175 BU I1 DING I �, �t I J 1 J' Dos R /u 1 - : ®x. a Page 2 fie
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c i Internet: www,tigard- or.gov Notified/Method! i gi Supplemental Information
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0 New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea, 1 Total
J Addition /alteration/replacement ❑ Other: New 1- 2da0y dwellings (includes 100 ft. for each utility connection)
t V5 a x ty r ar t t a r »
ql'* s : w, ,��� r� �j "� a s � a d � ' t t t ' 4 �N a � t o i� !I'ti�+ vxr • SFR (l) bath 3 12.7f)
f st ains •' It � 4 ,., , ,,A, , ,t, cartr�r` ti.., na,4;1.- ai ,h.,11 ,, tbl i�.a, aliaA1!"kC
IA 1- and 2 - family dwelling ❑ Commercial /i ndustrial Shit (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building 0 Multi- family
Each additional bath/kitchen 25.02
O Master builder 0 Other Fier sprinkler (___ sq. 0.) Page 2
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r t�l t Pi :icty46 f!a" v 1�s ( t i ,y' ee qr 4 : l , r y ; rt �'rkr* t utilities: �,I,. x&!' �] .,,, � l j + 4,. ts, ra:rg .e , , i ^ .us =u xtr .,4Y ,'rtlt 'uY, ri SIte uti
1 , S 3 G _ :�`Q' Jut , t e r C2 C.�. Catch basin or aria drain 1$.76
Job site address: -
7.1P: \ [y � `' p>� q-� a � ,
Drywell, leach line, or trench drain l 8.7ti
City /State /
1 1 rh 3 A /7�V/� Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: Projcct name: ,, - -A, n . -- : - ® Manufactured home utilities 50.03
Cross street/directions to job site: - t ' - It o - j - Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear it.: _ ) Page 2
Storm sewer (no. linear R.: ) Page 2
Water service (no. linear (L: _) Page 2
Subdivision: 1 I,.otno.: Fixture oritem:
fax map /parcel no.: Backflow ptsventer 31.27
r l rag , rr. 1 • ��ytrr a7 vt 1 10A pr ps r . 4 z . s . + , rim - i� i ' y t�I Backwater valve 12.51
'.P 8 v '44 'ukii i:lih '.1 ar t ; r, t ' =MVIA, aaa
Clothe; washer 25.02
` VN ." :I Dishwasher 25.02
` Drinking fountain 25.02
� i Ejectors /sump 25,112
-
2121 4 1 1 P '.*: r :••1'4 v' l• , • ( O i n !'i�ft 3� a; .. t•, ,t . r, ,... ,,) ,•0,h,`' L i tank 12.51
Name: ��( LE el]�� Fixtur Iscwer cap 25,112
Floor drain/flour sink/hub 25.02
Address: 5/9/`1 Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
-
Phone: ( ) Fax: ( ) Ice maker 12.51
�" . " ,,.: . ,1 r r s+l ti. t,!•"` a utura(ctu t '2''u, Interceptor /grease trap - 25,02
1Yr(:11 1 :hP ° +' .�, t,r") .�M� � p;f ,r. t�, , t G a klaslG Cad +l -
Business name: Medical gas (value: $ _) Page 2
Printer 12.51
Contact name:
Roof drain (cotrunen:ial) 12.51
Address: Sink/basin/lavatory 25,02
-
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax :: ( ) Tub /shower /shower pan 1 12.51 1491. c j
E-mail: Urinal 25.02
Water closet 25.02
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Water hCaur 37.52
Business name: I l? 1 A011.. r/ Water piping/DWV 56.29
Address: 1P0 k ,,Bq3 J - - other: 25.02
City /State/ZIP: 1 � 4 t A.i i ■ Z OI Subtotal 1 I 5�
-7 Minimum permit fcc: $72.50 1 a, Z
Phone: 0:1? � �- ( I ` (� ` Fax: (�� ) ��� -' l� Lo Minimu
Plan review (25% a permit fee)
CCB Lie.: Plumbin Lic. no.: - 0
A J i
State surcharge (12% of permit fcc) G. ") D /
Authorized signature: ' r di TOTAL PERMIT FEE %1 ,j 17
- ' r Date: This p ermit application expires if a permit is not obtained within 1a0 days
r ,.nrr it has been accepted Al Compietc_
"Fcc methodology set by Tri ('aunty Building Industry Service Board.
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