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Permit 'tom - ( CITY OF TIGARD PLUMBING PERMIT q COMMUNITY DEVELOPMENT Permit #: PLM2010 00233 y: } Date Issued: 07/21/2010 ,aTaGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 , -: : Parcel: 1S134DC01900 Jurisdiction: Tigard Site address: 11740 SW 114TH PL Subdivision: 114TH PLACE Lot: 12 Project: Dehaven Project Description: Shower pan. Owner: FEES DEHAVEN, RUTH A G & DANIEL W Quantity Description Date Amount 11740 SW 114TH PL TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 07/21/2010 $12.51 PHONE: 1 12% State Surcharge - 07/21/2010 $8.70 Plumbing 60 ea Minimum Fee Adjustment - 07/21/2010 $59.99 Contractor: Plumbing M D PLUMBING 939 SW WILLOWCREEK DR BEAVERTON, OR 97006 PHONE: 503 - 267 -3914 FAX: 503 - 533 -2075 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: ,� ` Permittee Signature: CaII 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 t sv Building Fixtures �'� - ,� r(Ilz um( l: 1 .,i. O\t:l Received City of Tigard ' ' � �' 7 „71. 1 t Permit No.: p 1 r\ - vo)-33 V 13125 SW Ha Blvd., Tigard, OR 9722 `\/ r / �! 1 ! U 11 11 t . Phone: 503.639.4171 Fax: 503.598.1960 J \ . ' gib i _ . Other Permit No.: Inspection Line: 503.639.4175 + ' ' T I G A R D , I e a , i'. ate Ready/By: funs: ® See Page 2 for Internet: www.tigard or.gov .": " ` . ,��°�,. Notified/Method: Supplemental Information TYPE OF WORK \ \ {� FEE* SCHEDULE ❑ New construction For in ormation use clkecklisx ❑ Demoliti � � 1 Description 1 Qty. 1 Ea. 1 Total 1RLAddition/alteration/replacanent ❑ Other. New 1- 2 -family dwellings (includes 100 R for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 g 1- and 2- family dwelling ❑ Commercialindustrial 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. R.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ,' 740 5 W / 14' l Catch basin or area drain 18.76 C J, Drywell, leach line, or trench drain 18.76 17 0,r © ' ` City / State/ZIP: , R / /Z Z 3 V �7 C ''�� !� , X?J'- / Footing drain (no. linear ft: _, Page 2 Suite/bldgJapt. no.: Project name: 0 rr)Vr " 4 14 . A\ Manufactured home utilities 50.03 Cross street/directions to job site: /2_ / S / ?� /(/' Manholes 18.76 Ram 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: I Lot no.: Fixture or rhea Tax map /parcel no.: Baddlow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 1 { Clothes washer 25.02 Nt S kl)vver \ (\ 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 Medical gas (value: $ ) Page 2 Business name: l u,.,, t it � Primer 12.51 Contact name: M� r K F L G 0 Roof drain (commercial) 12.51 Address: ! (,r/ � Ovf/e,ree K ` Sink/basin/lavatory 25.02 City/State/ZIP: V. D 9 7 ©06 Solar units (potable water) 62.54 Phone: (S03) Z e7,- 39 i Li I Fay : (SW) S 3-- 70 T 5 Tub/shower/shower pan 1 12.51 12. CO Urinal 25.02 E-mail: /0 , ,n2G©r,A- -1(Q Vek k ©O . Lc. Hit Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: Mf� P I um t(V1 1 �-- Water piping/DWV 56.29 Address: yL s L✓ / /n�G r cl1 Other 25.02 City/State/ZIP:.Q d• 0 97e06 Subtotal Phone: (Spy) 24 7 .9/.9 Fax (32, 3) 53 3 20 7,Z; Minimum permit fee: $72.50 72 5 4 4r .92‘ CCB Lic.: / � 8 Plumbing Lac. no.: / // //� Plan review (25 %of permit fee) State surcharge (12% of permit fee) 0 AuthAuthor/144i a ll re �i,�e f J ?� L- TOTAL PERMIT FEE 2;J) Paint name: y1I] / Date: ' /, The permit application expires if a permit is not obtained within 180 days < . fX i1 t �� I �� / ` O 1 after it has been accepted as complete. rJ / 'Fee methodology set by Tri -County Building Industry Service Board. 1:\ Bo tding\Pe,mits\PLMU- renmtnpp.doc 10'01/09 440- 4616T(10/02//ooM/WEB)