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Permit IN UP q CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2010 00237 'el G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/22/2010 Parcel: 2S103DC04700 Jurisdiction: Tigard Site address: 13855 SW 114TH AVE Subdivision: VIEWMOUNT Lot: 35 Project: Vaternick Project Description: Master bathroom addition. Owner: FEES VATERNICK FAMILY TRUST Quantity Description Date Amount 13855 SW 114TH AVE TIGARD, OR 97223 2 ea Sink 07/22/2010 $50.04 2 ea Tub /Shower /Shower Pan 07/22/2010 $25.02 PHONE: 503 - 639 -9661 1 ea Water Closet 07/22/2010 $25.02 1 12% State Surcharge - 07/22/2010 $12.01 Contractor: Plumbing H & H MECHANICAL 5757 SE WILLOW LN MILWAUKIE, OR 97267 PHONE: 503 - 975 -9787 FAX: 503 - 659 -2979 Type of Use: Class of Work: Type of Const: Occupancy Grp: Stories: Total $112.09 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. c 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. ASSOCIATED CHEMISTS Fax 5036530409 Jul 19 2010 09:19am P002/002 Plumbing Permit Application Building Fixtures FOR OFFICE I1tiF., ONLY City of Tigard R E CEIVED Received • 13125 SW hall Blvd., Tigard OR 97223 Datesr: / to M r v , ,� r • . • Phone: 503.639.417 ( Fax: 503.598.196, ^ ` Plan Review Other Permit No. Inspection Line: 503.639.4175 JU� I� . ra _ io g 7 I IGARD D3tC Date Rc Rcadv /By: Internet. www.tigard- or, Notified d 0 ` Page I for ' T' ' u1 � l iiii• = •.' SI•i. E Suppleme+tal information Ji arl a `S. i .. ' ;g ',. ,ii4 -, _ - u : i4ii•C; Ri.: O.„,! ... ,,,,,,,Np -.. �� n�9 � ; 4 �:;: (( � ech .:-. r,. Ali- =...., , E , : .. !6i�1 1 t, . .r_ : . . , • p9 : i 'I, .... w,, y . M ,,' Iru 1 - '•'1 ,, - e Y' q, pa...�a• . _ ... ,. . u•,.Hii ' . � -� ^., i Iac•-' "} z z ?� •li ,'iI" -t- ' III ' w :, , t.!.i' �t PiiP «pdz T ❑ New construction L r•- ' p Mon Fors•ecial in 0rmaflon use checklist jg Addition /alteration /replacement ❑ Other: Description Qty. Ea. Total ,, • „ l . .- : Addition/alteration/replacement u New , Ne - 2- family dwellin • s (includes 100 ft. for each utility connection) 1 1 li!I ; : lJ.Ill IIi� :II A •t ' 111 flail +t'- .' t q{i , i I!!! {': ..,f44 i r. , • r:: •.<:. .ihiii:il ', I � ,„ . u .'a ,( r 3' s es, ! :' '' t., e i © 1� : ,l �Ilrnl 1 . it � vi: {{ .l i f ?! SFR t I) bath • ksr`,fikklif imte,. r , . 312 70 Li► I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 • ❑ Accessory building ❑ Multi - family SFR (3) bath 500.32 ' Each additional bath/kitchen 25.02 C ❑ Master builder ❑ Other: M Fire sprinkler ( s t ' 11111 i, .t1.,. Irl � � `,9� „ r t, ��e �',��,• 45 :: ! t uiigii00i 'ii5i .:,r.;.°. y- t ) Page 2 t' -:_k1 ..41111 1 .L.,. (i1 ik 11Ihi ' !>i(EaTI] 'iit . 1- a9 ltii . t ", ,l gltl< i'.!ff l ltlt if te ut ii l ls∎t Sii Job site address: / _3 '$ ,5 57(...) ff= /A /�dE Catch basin ig.7b City/State/ZIP: - or leach line. or trench drain l jz -, _29 ` J~ 3; z.,-z3 Footing drain (no. linear ft.: _) Page 2 1 Suite/bldg. /apt. no.: i Project name: Manufactured home utilities 50.03 I Cross street/directions to job site; Manholes 18.76 Rain drain connector 11111.35 Sanitary sewer (no. linear ft.: _) E Page 2 Storm sewer (no. linear ft.: ^) P age 2 ' • Water service (no. linear ft.: _ ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventcr F _ ,r in I _, „ a �nrrz :. !: ?.,l!:lliiig!;:94,.;.viii .. Backwater :=ice il. �{iµp!.1 . �' ► nn a =iii •a• I, , .. kia,:, !'ziiiru'�- ��`i(i� ater valve 12.51 IMO :: -ill K' .. E 11 .1411 I ""ta t !,�if •r .: ' i` l:i . ::'i l) ::' i ,'�} II . ; _f''":::-, _ , idi :. e�i?5t�wlS {i llili��1 • � IIR 6 :...It illy:.: .I:: E.5?illut �;''- :1•`'iF a ' Clothes washer zs "o2 �j/fr'�+ D s 7 ! i ��7 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 st ll 1I1 S I` 1 u'�1ut;:�Y ,riq sl 8. �� i }'7C , , y / t'i .l h` � t i 1 2 ''' 1.i - : , d i # t }{ S .::I i:vEfly yl q 9 ,: 1 ;aril• °.t• ;n . ,a Expansion tank �� �-- .......:� ��.:".i11ulft ? uc�11I 01RG` 3 - = � - c4 .... t.. U h i ?:o:!i alit , _.:. e , e• . _: l f o � ' ..: Fixture /sewer cap 25.02 Address: Floor drain /floor sink/hub 25.02 • City /State/ZIP: Garbage disposal 25.02 Phone: ( ) , Fax: ( Ice ma I Hose bib 25.02 Pho 'f� i. ) [ maker 12.51 f l a! �i ' ;ii, : „l! 5 i i i n te rs for /grease trap 02 •Me > LM�, w>:T. -. -A e„ f�;�Lri::- �V.,�, .. 1 i;a= :.. ,� ..': , ,. A„ , � P a. Business name: Medic gas (value: $ ) age 2 Contact name: Primer 12.51 Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 CityIStatefZlP: ' Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub/shower /shower pan 12.51 c E -mail: Urinal 25.02. - r _, y� �:a, z� el.a., ::_ I -- ' 1 ' '�`�, t a •f'�i� r p - s. Tli:;i� • !Y �'i;' �Si1['i a ::� : ; r closet i 25.02 Business name: ,+ water heater 37.52 /� ., T e_441,4- '. L G..-? ] Water pipinu/DW V i 56.29 I Address: 5~'7 ,?' ,iii. f / .. _ - Other: rv. 25.02 City /State /ZIP; , 2 0 )1 0'( 6 3 74-6' Subtotal z.........,.--43 P o<.1 'hone: (Ta, ) . is ,.,c?' 7 i 7 I Fax: ( ') j -_ -, Minimum permit fee: $72,50 7 CCB Lic,: 1 7 .7(i z.� Plumbing I.,ic. no.:'� -•3 c -+/.9' Plan review (25% of permit fee) s State surcharge (12% of permit fee) is p/ id, 01 Authorized signature, PERMIT FEE / 4 /6. // 164,0 Print name: / Date: -7 / This permit appl;cation expires it a permit is not obtained �'[lbin 180 days GISt� 17 �� �,, / `/ ' / t) after it has been accepted as complete- "Fee methodology set by Tri - County Building Industry Service Board. I:Building1Permits% Mt idea 10 9 440 4616T( 10.02!COM /wEa)