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Permit CITY OF TIGARD PLUMBING PERMIT 111 C OMMUNITY DEVELOPMENT P ermit #: PLM2011 00086 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2011 Parcel: 1 S134DC01000 Jurisdiction: Tigard Site address: 11645 SW 114TH PL Project: NERLAND Subdivision: 114TH PLACE Lot: 3 Project Description: Shower and valve replacement. Contractor: ACCURATE PLUMBING & HVAC LLC Owner: NERLAND, DAVID A & MARGERY A 3021 NE 72ND DR #924 11645 SW 114TH PL VANCOUVER, WA 98661 TIGARD, OR 97223 PHONE: 360- 944 -8952 PHONE: FAX: 360- 896 -4870 FEES Quantity Description Date Amount 1 ea Tub /Shower /Shower Pan 03/22/2011 $12.51 Specifics: 1 12% State Surcharge - 03/22/2011 $8.70 Plumbing Type of Use: SF 80 ea Minimum Fee Adjustment - 03/22/2011 $59.99 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. Issued By: y / Permittee Signature: Call - • 9.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit A i)P iicatio AECE'V E D Building Fixtures MAR 2 1 2011 FOR OFFICE USE ONLY City of Tigard Reamed TIGARD pate • /, f jr Permit No.: Poi�'D/I)) - 4 _I if • 4 13125 SW Hall Blvd.. Tigard OR 97261TY OF \ Review li g al Re Phone: 503.7182439 Fax: sU >o 9 mom/ENGINEER I) r Re Other Permit No.: T t +, 1 K n Inspection Line: 503.639 Date Read:413y: h,ris: 65 See Page 2 for Internet: www.tigard- or.gov Notified/Method: /jf Supplemental Ink nastier, TYPE OF WORK FEE* SCHEDULE 0 New construction ❑ Demolition For special information use checklist Descri•tion aw. Ea. Total Li • ddition/alteratiotureplacement ❑ Other. New 1 -2- family dwellings (includes 100 fl. For each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 Dt 1- and 2- family dwelling 1 ❑ Commercial/industrial SFR (2) bath 437.78 © Accessory building El Multi-family SFR (3) bath 500 32 Each additional bath/kitchen 25.02 ❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: ! q1$' s. /iii , 7,7z Catch basin or area drain 1 8.76 Job site address: 7 " City/State/ZIP: �l� � f �� -7�� Drywell, leach line, or trench drain 18.76 City/State/ZIP: 7741 Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt. no.: Project name: pier Manufactured home utilities 50.03 Cross street/directions to job site: I - Manholes 5/ of e - Rain drain connector Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft. ^ ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Baekflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 2 ' -4 :A.% - ` ' Dishwasher 25.02 Drinking fountain 25.02 Ejectors/ sump 25.02 C 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 /Slate/ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City /State/ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax :: ( ) Tub /shower /shower pan / 12.51 E - mail: Urinal 25.02 Water closet 25.02 COI\`TRACTOR Water heater 37.52 Business name: e.AT. y / ir�( P ehlf/ i , 44G Water piping/DWY N 56.29 Address: 0 2 . 1 ,, .• Z Other: 25.02 City/State/ZIP: -- _42. G' Subtotal Minimum permit fee: $72.50 • Z• fed Pttone:Js� )9�S` •Ri'S -- Fax: (7 �4 " �L) Plan review (25'Y, of permit fee) CCB Lie.: /97/ $/r 1!L Plumbing Lic. no.: / 40 9Q Authorised si afore �/� / ` State surcharge (12% of permit fee) ? ° /, -�. r // TOTAL PERMIT FEE W.2.6 a application permit This ,� �, �_ _ -- _ 3//9,4/ s perm ap it h been e a n permit is not il teed withi Print name: within 180 days �• L G , „�� Date: a fter it has been ac it as complete. °Fee methodology set by lri- County Building Industry Service Board. I:1aatldito Pertnt LMMtI- PermitApp.doc MOM) 440 44167(10. g'd