Permit spy /� L.L: toot
CITY OF
TIGARD
PLUMBING PERMIT
x
:- : COMMUNITY DEVELOPMENT Permit #: PLM2010 -00060
Date Issued: 03/03/2010
iTIGAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S104AA11100
Jurisdiction: Tigard
Site address: 12305 SW 128TH AVE
Subdivision: BELLWOOD NO. 3 Lot: 130
Project: Long
Project Description: Install (2) lays, (1) tub /shower, and (1) w /c. 5/13/10, adding (1) dishwasher, (1) garbage disposal
& (1) sink to scope of work.
Owner: FEES
LONG, THOMAS AND CYNTHIA Quantity Description Date Amount
12305 SW 128TH COURT
TIGARD, OR 97223 2 ea Lavatories 03/03/2010 $50.04
PHONE: 1 ea Tub /Shower /Shower Pan 03/03/2010 $12.51
1 ea Water Closet 03/03/2010 $25.02
1 12% State Surcharge - 03/03/2010 $10.51
Contractor: Plumbing
POWER PLUMBING CO 1 ea Dishwasher 05/14/2010 $25.02
PO BOX 19418 1 ea Garbage Disposal 05/14/2010 $25.02
PORTLAND, OR 97280 1 ea Sink 05/14/2010 $25.02
PHONE: 503 - 244 1900 0 12% State Surcharge - 05/14/2010 $9.01
Plumbing
FAX: 503 - 244 -8825
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $182.15
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
applica.: •. • • k will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
is ..nce, or if work is sus. - ded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
tility Notification Center. Th. -e rule - e 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 • , g 5C • ' 6.6699 or 1.800.332.2344.
Issued By: _ 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.
q CITY OF TIGARD
PLUMBING PERMIT
' �- a COMMUNITY DEVELOPMENT Permit #: PLM2010 -00060
T t GARB. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/03/2010
Parcel: 2S104AA11100
Jurisdiction: Tigard
Site address: 12305 SW 128TH AVE
Subdivision: BELLWOOD NO. 3 Lot: 130
Project: Long
Project Description: Install (2) lays, (1) tub /shower, and (1) w /c.
Owner: FEES
LONG, THOMAS AND CYNTHIA Quantity Description Date Amount
12305 SW 128TH COURT
TIGARD, OR 97223 2 ea Lavatories 03/03/2010 $50.04
PHONE: 1 ea Tub /Shower /Shower Pan 03/03/2010 $12.51
1 ea Water Closet 03/03/2010 $25.02
1 12% State Surcharge - 03/03/2010 $10.51
Contractor: Plumbing
POWER PLUMBING CO
PO BOX 19418
PORTLAND, OR 97280
PHONE: 503 - 244 -1900
FAX: 503 - 244 -8825
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $98.08
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: __.k it 1 l 1 \ (`,• Permittee Signature: ""-Q A-V19
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.
X1 25 /2010 /FRI 11;10 AM PNEP PLUMBING FAX No, 503 244 8825 P. 001
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JlumbinF Permit App1icati tl•
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Ph 503.639.4171 Fax: 503.598. r 4�ARD pare/By: Outer Permit No.:
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I G � one: Inspect Line: 503.639.4175 !� i pate Ready/By: 80 See Page 2 for
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- Description 1 Qty. ; Ea. E Total
• ddition/alteration /replacement ❑ Other: New J -2- family dwellings (includes 100 ft. for cach utility connection)
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it ii r g�+ . s .� ry a .4 I e , - ( n U i " I °. :,- ; . SFR 1 _ b ath 3 .
►7.4 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ['Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler sq. ft.) Page 2
'r rO. u� yi t' a n n `o ,''.. 1[1 rr, * r o 1 site utilities:
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Job site address: 12 3f7 5 {.A.� 2S
. _ Catch basin or area drain 18.76
-7 Drywall, leach line, or trench drain 18.76
City /State /ZIP: _ • i (V Q r .)- Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
~ry
Cross street/directions t0 job site: Manholes 18.76
Rain drain connector 1 18.76
- Sanitary sewer (no. linear ft.: ) i 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
r •' u ni e , , h rs n: s t , ,w .. • i t i M � ei fil r Backwater valve 12.51
i t le f riar t s l.„ ,,! ` w n' , d� l �W,,. . ` ,.. . : t A-' A ∎4 o .e N . 4 . 4 ttuG Clothes washer 25.02
.�t_11�.._ n, , WJ.
° it /.I el a !_i • e Dishwasher 25.02
14 ( 16 t • S i • A Drinking fountain 25.02
A + Ejectors /sump 25.02
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la , ' ■ e ;'..~,, �y s Expansion tank 12.51
.il,ASu d ® .10 110 � .vd :. ,4Z Fs ( +7 + ...! I.∎ . I177R. ' . r ?.. . ,, .
Fixture/sewer cap 25.02
Name: - r
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City / State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.5]
�j� I [� rtt+, :' t "'t,e S oo 17 �' I + ; 3 �{1{r� �it +' Interceptor /grease dap 25.02
rt '�44 y r y r l ' t_ti t t�1.. N� 5 jilt tltig ` ,,r 4g ..�( .If LI l. ai
Business name: / , 11 , 0 Medical as (value: S ) Page 2
Primer 12.5I
Contact name: i , (3 fly 1 1 Roof drain (commercial) 12.51
Address: P • ' o z- 1 Z Sink/basin /lavatory Z 25.02 5OO4
City/State/ZIP: f { C5Y q 1 2-t O Solar units (potable water) 62.54
�h n �^ -_ tl ♦ Tub /shower /shower pan f 12.51 12 � i
Phone: L �t13) d� � d • Fax:: (Jp3) � . � Z
Urinal 25.02
E-mail
%+.r ♦ ��, lie" ^e It r t� tr i4 m�z(iyp`I !} r+r �r �rx. }p M r F p4Y, x Water closet I 25.02 Z,5d
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m. r . , , i.: ,t,(a. rr_ Water heater 37.52
Business name: ' 1 Water piping/DWV 56.29
Address: EP L° - j. --LA.
_' AA /Al la (, /'�/ Other: w 25.02
1 City/ State/ZIP:
"1 i Of 1 2--,).--3 Subtotal 2751
Phone: (6-03) LH ` 1 1. Fax: 603) DA.14 1 ��
Minimum permit fee: S72.50
Plan review (25% of permit fee)
CCB Lic.: 6 7 Plumbing Lic. no.: 34,1 5Q /7
State surcharge (12% of permit fee) r D 5 1
Authorized signature: . P ilMIN 7 TOTAL PERMIT FEE e i- D
Print name: , l !
Q, C+ c� m ` .p , . fr Date: e2 .24 /0 This permit application expires if a permit is not obtained within 180 days
after it has been accepted es complete_
"Fee methodology set by Tri-County Building Industry Service Board.
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Received
w t l,s + i � w Tigard �� Daten3 P en ni No.: B "00
i , ' r 3 1 1 Hall Blvd., Tigard, OR 97223 . 6, Plan Review Other Permit No,:
° k ' 03.639.4171 Fax: 503.598.1960 2 /0 l Date/By:
r� ln..action Line: 503.639.4175 ( Dare Read /B luriE: 81 See Page 2 for
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Ole Or,Stry ', � y, _ Desert .tion _ } Ea. Total
i • d.' n1a1 f' ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
ti jc" }'; t +ti la y t �° t+ t t /r r .70
�a a'��:en t.y npi� ��, r� "' SFR bath 312
SFR (2) bath 437.78
-! nd 2- famiiy dwelling ❑ Commercial /industrial
SFR (3) bath ■ 500.32
❑ Accessory building ❑ Multi-family Each additional bails /kitchen 25.02
❑ Master builder ❑ �� '�
Other:
p ��,�¢ Fire sprinkler (_,_„_, sq. A -) Page 2
by a i,' irk . t m er x r f zr r I+ t ` r S ,,, ,
t` i s .' r; t t o t F° Site utilities:
1 ' , - t..;;el, ,. y _' .n .n f '" '''I'' k:.'' y.t "'''tr ntnw t.
Job site address: � aS a4 ■ "4 t - Catch basin or area drain 18.76
Drywell, leach line, or ucnch drain 1836
City/State /ZIP: /, d', / yi a ' 7 Z23 Footing drain (no, linear 8.: _) Page 2 MI 4
Suite/bldg. /apt. no,: Project name: e ` -li ( . Manufactured home utilities 50.03
Cross street/directions to job site: 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. Iinear ft.: ) Page 2
Subdivision: 1 Lot n0.: Fixture or item:
Tax map /parcel no.; Back preventcr NM
-� n ° t. •, :7,,•, -4a .m Bacicwatervalve
s.ff'h��,�+g r 65"" I 4 ,. tt •ti . .F' nu f w,r • r % F n ° i' l �" ' T v .
.,-„, i S M ,.u .9-,1 3 1 , 1 + ..�Joi t "' 1 0r�,k ..,. . t .. Clothes washer 25.02
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7 /. . / _ Dishwasher Eli 25.02 i5.02___
Drinking fountain IM 25.02
/ , /,L1 P i' 2D 1 1 / . Ejectors /sump 25.02
5 d4 13' 0w yrf eeo- ,r }aa r ., d ®I °I`' !iltr.i'}J Expansion tank 12 -51
Fixture/sewer cap_ 25.02 . III
Name: Floor drain /floor sink/hub 25.02
Address: _ Garbage disposal 25.02 Zs-°O -
City/State /ZIP: Hose bib 25.02
Phone ( ) Fax: ( ) Ice maker NM 12.51
z ";. sin. e 1 rt " '' �kir »^ rr • I� u ° , ''" v' A r`, t Interco for /grease trap 25.02 • T'aci n lrvB Qt .11 ° � •r•'1 w • • w 4 l tl ' Yee ' iuirr l° • ' ri .,, .' 4 /+ "t 9 p
:eti:m rvw u.r., w v
Medical gas (value: $ ) Page 2
- Business name: r6 ! Al O •
� 1 Prima 12.51
Contact name: '-'1/" f ii) A i/1 1 �• Ro•f drain (commercial) 12,51
Address: 0 50 X i qu 1$ asin /lavator - 1 25.02 25 -0
City /State /ZIP: / 4 / 4 0 ,' 17 z - Solar units (potabie water) 62.54
Phone: ( ) _ ./.. /1 Fax :: (gyp ) • _ Tub /shower /shower pan 12,51
L J Urinal 25.02
E-mail: r c 25,02
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I y n ifs = •Il . ; ;s�. . r.. r. .IrR• Water heale 37 -52
Business name; C.!' - Water piping/DWV ■ 56.29
Address: �Q / 9y/ Other: 25.02
Subtotal • 0 .
City/State/ZIP: / / / 7z Minimum permit fee: $72.50 r
Phone: ( ) / • Fax: ( ) 5a.....ypLe
Plumbing Lic, ho.: _Plan review (25% of permit fee) -
CCS Lic.: .r 1 S7J P el 1
$t a l c sur ( 12 /o of permit fee) t
Authorized signature: ...., TOTAL PERMIT FEE ( L4.0 7
This permit application expires if a permit is not obtained within 1811 days
Print name: a . `� S Date: 5 //b after it has been accepted as complete
"Tee metl odo7ogy scll2y Tn Co Building Industry Scrvicc Board -
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