Permit o CITY OF TIGARD PLUMBING PERMIT
.1141 t: •• COMMUNITY DEVELOPMENT Permit#: PLM2010 00365
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/05/2010
Parcel: 2S110AB02200
Jurisdiction: Tigard
Site address: 14315 SW 112TH AVE
Subdivision: COLE'S ACRES Lot: 8
Project: Spinelli
Project Description: Shower replacement.
Owner: FEES
SPINELLI, JEANETTE Y & DAVID J Quantity Description Date Amount
14315 SW 112TH
TIGARD, OR 97224 1 ea Tub /Shower /Shower Pan 11/05/2010 $12.51
PHONE: 1 12% State Surcharge - 11/05/2010 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 11/05/2010 $59.99
Contractor: Plumbing
JAY JAY'S PLUMBING
19447 E. BURNSIDE
PORTLAND, OR 97233
PHONE: 503 - 667 -8420
FAX: 503 - 492 -3863
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.
,,,,,,...„.....,4 .... 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.
Plumbing Permit Application
Site Utilities ��JC�.t 100 I FOR OFFICE r 11 ON L1
City of Tigard ll°" 4 2010 Rece i ved f ' '� Permit No.: III • 13125 SW Nall Blvd., Tigard, OR 97223 �� I 1/11 f/ PIm J _ ut 3
C Phone: 503.639.4171 Fax: 503.598. I960 \,,(7\\I Dat�ay ticw Other Pcrnot No.:
'i' I G ,^ ii D Inspection Line: 503.639 F ,S1G � . r -. Ready/ay: kris: ® See Page 2 for
Internet: www.tigard- or.gov j - �1S1,1 fiediMethod: . '1(y Supplemental Information
TYPE OF WORK „ -MD FEE* SCHEDULE
❑ New construction I 0 Demolition For special infornratfon use checklist.
Description [ Qty. 1 Ea. 1 Total
J grAddition/alterati /re placement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
� CATEGORY OF CONSTRUCTION SFR (1) bath 31230
Ird"i- and 2- family dwelling ❑ CommerciaVmdustrial SFR (2) bath 437.18
❑ Accessory building
SFR (3) bath 500.32
❑ Multi - family
Each additional bath4citchen 25.02
❑ Maier builder ❑ Other: Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: 1 43 1 6 - S_, , 1 i „,,,-7}4. w. Catch basin or area drain 18.76
City/State/ZIP: t'P� Diywell,1each line, or trench drain 18.76
Footing drain (no. linear R: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: S i
�� s Pi /Y-L r' � i Manufactured home utilities 50.03
Cross street/directions Lo job site: Manholes 18.76
Rain drain connector i 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear 11.: _) Page 2
Water service (no. linear ft.: 1 Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK `Backwater valve 12.51
j Clothes washer 25.02
' eA VW -n 6 to wen_ - ' Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
"(PROPERTY OWNER I ❑ TENANT Expansion tank 1251
Name: �� /� Fixture/sewer cap 25.02
��rr
,�_ f Floor drain/floor sink/hub 25.02
Address: r 436 A t" f 1 i Garbage disposal 25.02
City /State/Z1P: -ft GrA.RD / t7'i / Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
r . PPLICANT ,dONTACT PERSON Interceptor /grease trap 25.02
,.. )� 1e Medical gas (due: $ ) Page 2
Business Dame:
,� � Yii s i�//11Y soya. A1�. - Primer 12.51
Contact name: NAT! i....0- - C m rilA
r Roof drain (commercial) 1251
Address: E 1 f'- 3N�I•;S) C) `�T- Sink/basin/lavatory 25.02
City/State2lP: g .7 O k .. 4:77.27-3 Solar units (potable water) 62.54
Phone: (9234 Fax: : ) 4. Q 2 _ �rIQt - Tu ow howcr pan / 12.51 0, , 5 r
ail: v 1 Urinal 25.02
>rtn ri e el' � j i _ • C� 11(1 Waiter closet 25.02
CONTRACTOR
1.. 1 Water heater 37.52 _
_
Business name: V 1i 5 ii.[At �..� i I IV e, . Water piping/DWV 5629
Address: 119 4 7 &RBI ng G am ' Other. 25.02
City/State/ZIP:P m _ rJ R _ 972,33 _ Subtotal
Minimum permit fee: $72.50 , 9
Phone: (660) 44,143 `,(2.0 Fax: (5 ) 49R -3e(03 Plan review (25% of permit fee)
CCBLic.: :1-} 332 . ei'/l'�) I Plumbing Lic ��
no.:. f17
O II State surcharge (12% of permit fee) 8 a '10
Authorized signature: ' f,,,,.tiw>ti�r �J i r i 1/11 ,cp TOTAL PERMIT FEE ¶ 31 . xA
T J
This permit application expires if a permit is not obtained within 180 days
Print tlatrle: a a:• 131. _ LA _CM Date: �� - 0 after items been accepted as complete.
"Fee methodology set by Tri.Cotmty Building Industry Service Board.
I. Ouading',PomaaPLMU- PamitApp. I WOI/09 4404616r(10/091COM/WFB)
Z ' d £99£Z617£09 H11 INS N2>I BL0 :60 01. 170 AON