Permit 1 CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMEN Permit #: PLM2011 -00105
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 25111 DB09900
Jurisdiction: Tigard
Site address: 15495 SW OAKTREE LN
Project: McRivette Subdivision: Lot: 0
Project Description: Replace existing fixtures and add (1) lay for residential remodel.
Contractor: SILVER MOUNTAIN PLUMBING INC. Owner: MCRIVETTE
14735 SW BONANZA CT. 15495 SW OAKTREE LN
BEAVERTON, OR 97007 TIGARD, OR 97224
PHONE: 503 - 644 -2123 PHONE:
FAX: 503 - 574 -3252
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/06/2011 $25.02
Specifics: 1 ea Garbage Disposal 04/06/2011 $25.02
ea Ice Maker 04 /06/2011 $12.51
Type of Use: SF 1 ea Sink 04/06/2011 $25.02
Class of Work: ALT 3 ea Lavatories 04/06/2011 $75.06
Type of Const: 2 ea Tub /Shower /Shower Pan 04/06/2011 $25.02
Occupancy Grp: 2 ea Water Closet 04/06/2011 $50.04
Stories: 1 12% State Surcharge - 04/06/2011 $28.52
Plumbing
Total $266.21
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 ication Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir t questions to OU . b in. .03.232.1987 or 1.800.332.2344.
Iss d By: I i Permi e Signature:
Call 503.639.4175 by 7:00 a.m. for the next available ins . • ction 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.
Apr 06 11 08:17a 5035743252 p.2
Plumbing Permit Application RECEIVED
Building Fixtures
_ City of Tigard R, - ? f Received
III
13125 SW Hall Blvd.. Tigard, OR 97223� Date/B 4 % Permit No.: ����� /� �
Phone: 503.718.2439 Fax: 503.598.1h TIGARD Plan Review
Inspection Line: 503.639.4175 BUILDING OF Rp Date/By: Other Permit No.:
TEGA1tD Internet: wwwti ardor, ov Byid DateReadB
g g D IVISION NotiftedIMetnod: Jufi 1 la Sec Page 2 for
TYPE OF WORK
Supplemental Information
FEE* SCHEDULE
New v construction ❑ Demolition For special information use checklist
Addition;alteration /replacement Description Qty. i Ea. Total
Other: New I- 2- family dwellings (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath
312.70
Ef I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
-
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other.
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /5-{4 Q s 1�'C< L � _ Catch basin or area drain 18.76 1
City/State/ZIP: 7- t •„� 6' 02 q��.`f Drywell,leachline,ortrenchdrain 1g 76
Suite /bldg. /apt. no.: V I Project name: I Footing drain (no. linear ft.: ) Page 2
G i v e of Manufactured borne utilities 50.03
Cross street/directions to job site: J
Manholes 18.76
t Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: r Water service (no. linear ft.: _J P age 2 E
Lot no.: Fixture or item:
_ I
Tax map /parcel no.: Backnow preventer
31.27
DESCRIPTION OF WORK Backwater valve 12.51
f�iGSri �hj jGt( ��� (�s Clothes washer 25.02
Dishwasher l; 25.02 ,:)& 0 ,,P.. I
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 1 25.02
Address: Floor drain /floor sink /hub 25.02
City /State/ZIP: Garbage disposal ' ` 25.02 a sj -o I
Phone: ( ) Hose bib 25.02
Fax: ( ) Ice maker
®'APPLICANT 15.5 12 1
❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: i h, Medical gas (value: $ ) Page 2
�,��� Pita., . , rT-e.
Contact name: ; G, rx� k , Primer
12.51
Address: C Roof drain (commercial) 12.51
l 4 - 3S S1J-1 -6a'^c)` ^? a. Q.A Sink/basin/lavatory Li 2 5.02
City /State/ZIP: � eo-,t ertnti. 0 ' - r -r 1 100,04? i
t 2 Solar units (potable water) 62.54
Phone: (Sa 3) `1_ yS7�1 Fax:: (So
3) 5'74 - 3a$ Tu b / shower /shower pan a 12.51 ?5- l
E mail: V� Mov n i- Urinal
vwti, ®. m S t� - C.- -.
Water closet 25.02 25.02
C ONTRA CTOR
5/) D)..4 , I I
Business name: �/� ) Water heater 37.52 .
V e fr ` d �` 1 u.p ` �r�C . Water pipingiDW V _ 56.29
Address:
1‘-‘ - 1 3S So-) }�or`Ahzo� 34.. Other: 25.02
City /State/ZIP: � �av¢.r O g g7t0T
Subtotal
Phone: (451)3) 6'14 - ? 1 3 Fax:
(�33) S 74 -3 a 7 /////
Minimum permit fee: 572.50
CCB Lic.: a 3? - �n 9
S ( i 7 � s�o pJ /��� Plumbing Lic. no.: 34, y ado Plan review (25% of permit fee)
Authorized signature: y/► .j(/t� State surcharge (12% of perm it fee) _aeb . a
�3 r " cj i, ao- J / V • TOTAL PERMIT FEE 1
Date: �i 1 t )�
This permit application expires if a permit is not obtained within 180 ay
Print name: �a r�v� m rya ) I S/ 1 I after it has been accepted as conpkte.
"Fee methodology set by Tri -County Building Industry Service Board.