Permit CITY OF TIGARD PLUMBING PERMIT
>z COMMUNITY DEVELOPMENT Permit 9: PLM2010 -00328
Date Issued: 10/12/2010
TIGAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S133DA07600
Jurisdiction: Tigard
Site address: 12612 SW SNOWBRUSH CT
Subdivision: Lot: 0
Project: Kruger
Project Description: Kitchen remodel; move hose bib
Owner: FEES
KRUGER, DENNIS & WENDY Quantity Description Date Amount
12612 SW SNOW BRUSH CT 1 ea Hose Bib 10/12/2010 $25.02
TIGARD, OR 97223 1 ea Ice Maker 10/12/2010 $12.51
PHONE: 1 ea Sink 10/12/2010 $25.02
1 12% State Surcharge - 10/12/2010 $8.70
Plumbing
Contractor: 10 ea Minimum Fee Adjustment - 10/12/2010 $9.95
MODERN PLUMBING Plumbing
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062
PHONE: 503 - 691 -6166
FAX: 503 - 691 -6771
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: 0-A/ / /e {l_7-70.
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the protect.
Approved plans are required on the job site at the time of each inspection.
Oct, 11. 2010 1:48PM Modern Plumbing No. 4257 P. 1
riumninz Permit Applicati
Building Fixtures' ' , ' �,
City of Tigard Received
13125 3W Ball Blvd., Tigard, OR 97223 0 r T r 2 0 l 0 DatdBy; /0 /Z /0 , C ?unfit 140.:,6,/i .�rl o 3 " g
Phone: 503.639.4171 Fax 503.598,1 %0 an Review
i i c; ,, i, i) Inspection Line: 503.639.4175 �4 �� :� Dix �her PermitNo.;
Internet: www.tigtud -0r.gov � Date Reedy/By: �G> Nolifiad/Mdhod: page 2 for
atlon
n 1.I p .� eatal ororm
❑ New construction ❑ Demolition
For s,..a.110-on use checkli'sc
I$ Addition/alteration/replacement 0 Descri tion
;I r
„. ri;:.1C: :; . New 1 dwellings
Total
2-fam
'.' '': ; :, .. :::,T (includes 100 R for each M
••i'...?'�:, ..,,4R- ONS``$` -:;;,, ,-." chudli action
;JC1"! SFR
: ,. ,. - ,': • : ,; :,` (1) bath 2 "70
41- and 2- fancily dwelling 0 Commercial/industrial SFR (2) bath
❑ Accessory building ❑ Multi- family SFR (3) bath 437.78
❑ Master builder Each additional — 500,32
- El Other: bath/kitchen MI 25.02
:. C % > . " Fire Sprinkler ( _ sq, ft.) Page 2
, :;';a : c:a: *lifi PJC.i...Nt�UIN0 4 14.6 .*,.. fi P e
.::, �: ,.... , rr: oN: � Site utilities:
Job site address: Lt..) c Catch basin or area drain
18 "76
City /State/ZIP; ^
0 C � ' . Drywell, teach lint, or trench drain 18.76
Footing drain (no, linear ft.:.___) Oa
SuitelbldgJapt. no,: Project name:
~ ,r. U Manufactured home utilities
Cross street/directions to job site: ties 50.03
Manholes MEIZIIIMI • 114.„0 A 4 e C r [ no ,
Rain drain connector I8,76
Sanitary sewer (no. linear ft: `� Page 2 111111 Storm sewer (no, linear $ �) Page 2
Subdivision: Water service (no. linear ft": _ Page 2 Lot
/ Fixture or Item:
Tax m
ap parcel n
o,:
ow prove r
_•` i�`�'';!!DT�- lfEl'AI� .... i Y.. .. -• ... aCl� me 31.27
;!
,•.. .. .' . + .... . `'Oltt w {,.,..`' <i N .iS. ✓.'< ' :- '. +:.',.. �' I O . Cl o h.= washer Va1Ve �
a. _
44 Clothes washor 25, 02
I r k. a Se . Dishwasher
25,02
Drinking fountain - 25,02
�s;: ?::. Ejectors/sump
';�+�;3�:� ., ; AOPEttTY: .. / +� ' .. � ,,; , , _ 25,02
Name. /+ M.J _ ".;' -. ..'� !.`Ii�.�:l i- 1 �^F t()rx try4� 12.51
x.C-C. . .. ... .. Fixture/sewer cap 25.02
Address: _s—e9.-Ai drain/floor sinlc/hub 25.02 Ell
City/State/ZIP: q �3 Garbage disposal
25.02
Phone: ( ) Hose bib III. 25.02 C 0
(
Fax: ) I
'F Syry',f �1'try..' a. J M_. 7� 4 YyM- .4':.! 4�..:'r ! Ice maker
,q.',,,, .�,C,;'r'. 41 i4 .,1 .( e��E,? =LV�?� �;• ' Interceptor/grease trap 25.02
Business name; liZal
Medical gas (value: $ ) �
Contact name: Primer � MN
Address: Roof drain (commercial) �
�
Address:
Sink/basiMavatory 11111 25.02
Solar units (potable water) 62.54
Phone: ( ) Fax:
( ) Tub /shower /shower pan 12.51
Urinal MI 25.02
E-mail:
:CONTRGq'pR'` Wator nines
Business name. MM.' '" ,. watt,. 25.02
, /' heater � �
Address: 0 J �' r ' • Water pip;ng/DWV 56.29
City/State/ZIP:
4 . , • Other: r 25.02
i • 0 / 7 06
bait: a Fax Subtotal Mill
/ D ) , q -b ` 1 Minimum permit fee: $72.50
CCB Lic.: �► aY, . , a I )
Plumbing Lie. no, i Plan review (251/4 of permit fee
Authorized signs ,' / State surcharge (12 °/4 of permit fee) a
-� y ,
_ -4 , _ •
Print name: Uj PERMIT FEE :
• 1 �/. ` Date; This permit application expires it a permit is not obtained witbic 180 days
after it has been accepted as complete.
'Fee methodology set by 7R County Building Industry Service Board.
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