Permit CITY OF TIGARD PLUMBING PERMIT
o COMMUNITY DEVELOPMENT Permit #: PLM2010 -00296
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08/2010
Parcel: 1S135 DB02600
Jurisdiction: Tigard
Site address: 11405 SW 90TH AVE
Subdivision: TIGARDVILLE PARK Lot: 0
Project: Powloski
Project Description: (1) dishwasher, (1) Ice maker and (1) sink for kitchen remodel.
Owner: FEES
POWLOSKI, C KENT & LISA Quantity Description Date Amount
11405 SW 90TH
TIGARD, OR 97223 1 ea Dishwasher 09/08/2010 $25.02
1 ea Ice Maker 09/08/2010 $12.51
PHONE: 1 ea Sink 09/08/2010 $25.02
1 12% State Surcharge - 09/08/2010 $8.70
Contractor: Plumbing
NORTHWEST CENTRAL PLUMBING CO INC 10 ea Minimum Fee Adjustment - 09/08/2010 $9.95
Plumbing
2870 SE 75TH AVE # 206
HILLSBORO, OR 97123
PHONE: 503 -642 -2067
FAX:
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 1.81
Issued By: l �_ 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.
09/08/2010 08:32 15038425954 NYCENTRAL #1064 P.003/004
Plumbing Permit Application •
Building Fixtures RECEIVED FOR OFFICE CSE ONLY
City of Tigard Received q / ,/ J 67 . 3 _ Permit No.: (L ft)� w- 02,14G 13125 SW Hall Blvd.. Tigard, OR 8 7010 Plan Review 1 /I�
.. Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No -: '-t- r k j- 4 09 K(e
t GARD TmPectron Line: 503.639.41750 OF TIGARD Date /ay= s e See roe
T Internet www.tigand-or.gov. Notified/Method:
- fNotified/Method: yt[ PYge S 2 lnf onmation
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For special information use checklist.
[]New construction El Demolition
Description 1 Qty. r Ea 1 Total
74 Additioi?/alteration/rcplacement ❑ Other. New 1-2-family dwellings (includes 100 R for each utility connection)
f
;tie. _, () 312.70
.• may- 4 _P3E 1:1 c ?; , iI; ._._.w.,.. : : t �h i . �
', FR 1 bads
n i ? - .rye• ' i•• : '� :c'' :•. t :.�,,��'i(Iln:_��?�' S
1d1- and 2- family dwelling 0 Commercial/industrial .. dustrial SFR (2) bath 437.78
SFR (3) bath 500.32
E7 Accessory building _ ❑ Multi- family additional bath/kitchen 25.02
❑ Master builder ❑ Other Fire sprinkler ( sq. ft) Page 2
=4�. :' •t { - Site ettlities-
- r Catch basin or area drain 18.76
Job site address: 1 'I 1 1- -- iljar • - , . Drywon, leach lime, or trench drain 18.76
.'. , :.11
City /State/ZIP: ' k "- 1 Z
� p - Footing drain (no, linear ) Page „-
Suire/bldgJapt. no.: Project name: r Manufactured home utilities 50.03
r
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18,76
Sanitary sewer (no. linear R: ) Pagc 2
Storm sewer (no. linear ft: ) Page 2
Water service (no. linear ft. ;) Page 2
Subdivision: j Lot no.: Fixture or item:
Tax map/parcel no.: Back$Ow preventcr 31.27
,...._ _. _.... - _ = - _ _ = _ - _ : Backwater valve ;r � ,:.,r.r _.,_ ...;_... -��., Back r alv 51 ' : =r7� :` y�-- •'� :t1i � �.•.:.'_ ;;r: n. '��.'i:i _'� : u_'yei1
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.: _.�. _...-- Clothes washer 25.02
a f ......• , A .2 41 a. ` _ Dishwasher I 25.02 7,5.0
Drinking fountain 25.02
Ejectors/sump 25.02
> • :::: .- 12.51
cr!+ r . , ._. r.� i_r�'2.,ui.,.;,- :c3�cros E :ter ; '' T= .- __- t� :iY. Expansion
�:�s�.. , . F ansion tank
3 4LVtl - f - r 1 yep � ';
Yd f :(.%! :� .'�- Yd ' �.4MZ : i''�'f'`I1f�.•_ __ _ :. , V :�Y�r � ��N�r1�.1I1 • ^• . Nffti::'I�Ik 1 ' , �rYh � ;:
Ram/sewer cap 25.02
Name:
Floor drnin/floor sink/hub 25.02
Address: _ Garbage disposal 25.02
City /Statch6I.P: Hose bib 25.02
Phone: ( ) Fax: ( ) ice maker ' 12.51 J2... S 1
'' _""-'"'4 `, �•'' ;�.rf,lnnit _ - ' _.'_ Interceptor/grease
J
-,,;, , � : rt 3 �' i-K `_u � Pmr � "P 25.02
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- '1�e` ,gyp :...•. ,- ....iWIIC y _�iptif�?: :_. - 'w,lE '_'_ =n •�er�'m "
:!•'� e 1•N,fo : --+ !, i - -c r..,e:.r� ' _ Medical gas (value: $ ) Page 2
Business name:
Primer f 12.51
Contact.name: Roof drain (commercial) 12.51
Address: - Sink/basin/lavatory 1 25.02 4
C
City/State/ZIP: Solar units (potable water) 62.54
Fax: ( ) Tub/shower/shower , pan 12.51
Phone: ( ) Urinal 25.02
E -mail _ Water closet 25.02
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,d?_?�« t ._._ =ra.� • ti_ _., : : : :�, r 4
. r- :._.., ' --- ='=" 4 "- ,04 t 4,-,= • , ' ,--- Wafer healer 37.52
Business name: , , - 1 , i , 1....t1 >• :. 11 t . � � L.L.■• %_, _ . s Water piping/DW V ~ 56.29
Address: '''2, 4 ' . 1 • FAQ ..0 25.02
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City/State/ZIP: II 7.1 r / .„ Subtot .
Phone: (- t (1i r , Fax: ( ) - , 2 . �J _, Minimum permit fee: $72.50 -- 12.„
� C � Plan review (2595 of permit &x)
CCB Lic.: 2 Plumbing Lic. no.: ''" 1 • ILA_ State surcharge (1 256 of permit fee) $ 70
Authorized suture: = 1 ' f ,_-.- TOTAL PERMIT FEE S` „Z
- T6it permit application expire; if a permit is not obtained within 180 days
Print name: 4 Mi um � • tari ' Date: b;', 1j . l , i. utter It Ma been accepted as oomplcte.
"Fee methodology set by Tri- County Building Industry Service Board.
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