Permit ; CITY OF TIGARD PLUMBING PERMIT
`'- 2 COMMUNITY DEVELOPMENT Permit #: PLM2010 -00231
TIGARD! 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2010
Parcel: 2S 102BD02600
Jurisdiction: Tigard
Site address: 12971 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Kim
Project Description: Install roof drain.
Owner: FEES
KIM, PENNEY Quantity Description Date Amount
395 NW SILVERADO DR 73 da Plumbing Permit 07/21/2010 $72.50
BEAVERTON, OR 97006
PHONE: 9 da 12% State Surcharge 07/21/2010 $8.70
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062
PHONE: 503 - 691 -6166
FAX: 503 - 691 -6771
Type of Use: COM
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: y �� Permittee Signature: / 77O /970/0
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.
Jul. 16. 2010 12:38PM Modern Plumb No. 2375 P. 2
PlumbingPermit Application
g �' r %` -.
Building Fixtures 1 . 1 tllc (:;I, It 1. 1 �t � 1
11011 ' , City SW \ --',-• N � � ooeive 9 /,'" / t , permit Ne u /Ad/0 -' 9t.' ' /
: ■ n 13125 SW Hall Blvd., Tigard, OR 97223 ��G teJB
S
® Date/B view
Phone: 503.639.4171 Fax: 503.598.1960 <1` D Other Permit No.-
Inspection Lino 503.639.4175 SC G e
I 1-`-.' 1 � !i' � ��` Date Ready/13y: Ca See Page 2 [or
Internet; www.tlgard- or,gov ` ` ��, Notified/Method , 1 Supplemental Information
TYPE 01? WORK V FEE* SCIHEDULE
❑ New construction ❑ Demolition For special infor»ra1ion use checklist
Description 1 Qty. f Ea. 1 Total
, Addition/alteration/replacement [f Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
I:1 1- and 2- family dwelling ikCommercial / industrial SFR (2) bath 437.78
❑ Accessory building SFR (3) bath 500.32
ry ng ❑ Multi - family
Each additional bath/kitchen 25,02
❑ Master builder ❑ Other: Fire sprinkler )
p ' (_ sq. ft. Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
n }� Catch basin or area drain 18.76
Job site address:
t ` ( 1 t f , ac th Drywell, leach lino, or trench drain 18.76
City /State/ZIP: Ti 9 a rt i cp
Footing drain (no. linear ft: ) Page 2
Suite/bldg. /apt. no.: 1 Ilroject name: K \ 1.A Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector _ 18.76
Sanitary sewer (no. linear ft.: T ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear it ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow prcventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
1(L .1 i, ft 7L �P- COI Dishwasher 25.02 25.02
'iZ t Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT 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
❑ APPLICANT . ❑ CONTACT PERSON . Interceptor /grease trap 25.02
Business name: Medical gas (value: $ _ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial)
f /
12.51 I Z;
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
T CONTRACTOR Water closet 25.02
C� - Water heater 37.52
Business name: a e 1e1 a l lA mk),
, ' 1 Water piping/DWV 56,29
Address: `, 4 2.D 5u„..) f\ (,V J , 1t i rL Wa44 Other: it 25.02
City /State/ZIP: LAIL I Q� � Q
-� p_ q - 6( Subtotal
)
r Pone: ( ) 503 G,(1 ( C ( Fax: ( ) 50369 ( (DT/ i . R Minimum permit fee, $72.50 '7Z-
CC Lic.: $ 0 , ✓ Plumbing Lie. no.: N n A� 1.4 CI Plan review (25% of permit fee)
�� `y s State surcharge (12% of permit fce) 7 1)
Authorized signature: / ,�4A_,L - -.- ..�1 f � I TOTAL PERMIT FEE g 1- Z.1.3 1/'
, Th' permit gpplicetion expires if a permit is nor obtained within 180 days
Print name: De c- 4, (.1 � ,
-i E r� O af : 7 1 (p (Q alter it hos bees, accepted as complete.
J
ktilittir
1oaY set by Tri•Coxniy Building Industry Service Board.
I:1 Huilding1Pennits \PLMU.PenritApp.doo 10/01/09 440.4616T(10 /O2/COM/WE2)