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Permit �� CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 -00165 • 1 3125 SW H all B lvd., Tigard OR 97223 503.718.2439 Date Issued: 06/01/2011 TI{r:4RI, Parcel: 2S114BB08700 Jurisdiction: Tigard Site address: 16288 SW 104TH AVE Project: Morris Subdivision: SWANSONS GLEN Lot: 28 Project Description: Install kitchen sink. Contractor: JOHN D PLUMBING Owner: MORRIS, MICHAEL N /GAIL A 7472 SW FIR STREET 16288 SW 104TH AVE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 - 620 -7600 PHONE: FAX: 503 - 598 -9355 FEES Quantity Description Date Amount 1 ea Sink 06/01/2011 $25.02 Specifics: 1 12% State Surcharge - 06/01/2011 $8.70 Plumbing 47 ea Minimum Fee Adjustment - 06/01/2011 $47.48 Type of Use: SF 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 1.800.332.2344. Issued By: • �--�` Permittee Signature: el/I/ /97 ,PL /e.5 70"/ Call 503.639.4175 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. MAY - 31 - 2011 11:50A FROM: JOHN D. PLUMING , ` (503)598 -9355 TO:5035981960 P.1 Plumbing Permit Application i !' Building Fixtures MAY 3 1 2011 City ofTigtlnd OF TlGA iD RKri� 5 3/ # k ( "!,af - � fee P hone 03.639A171 Fax: 35 ' , b1 D'►� D�v�S�O� tAtdRy. Pon Review Other Permit No.: Line. 503.639.4175 v �'O Other i ` . 1 i www.tlaardar Date Ready/By: / . -- 13 See YSte! for '� _ NtlrindUMAM4' V 1fYp IldaMenen ' . TYPE Qtr `WORK _ m... • FEE 8Cf[6DOI,E 1:1 New construction 0 Demolition mead krona*" *" sae ebtet� �. AdditfmYaheratlonheplacentett ©off �` n 1 Qty. i Ea. I Taal , New 1.2.family dwellings (indudm 100 ft. for each chill a onnection) • _ CATRCORt o! cosmetic* N SFR (I) bath 31230 0 1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 437.7E 0 Accessory building 0 Multi4emi(y SFR (3) ball 50032 ❑ Master builder Each additional bcth+kitchas 2102 ❑ Other: Fire sprinkler (_._ W. 0.) Page 2 JOR are 1NtioniiATlt)IV AND LOG►T1ON -. Site Mintiest deb site address: t / : Z SP 5(,o 1 ( Q (,. Ave. !L Catch brain or area drain 111.76 City/Stata2lP: TI (� t v 2 • q / Z 2-T Drywall, leach line, or trench drat 1176 Suite/bldg./apt. ooting drain (no, linear fl..: __ J Page 2 g apt. no.: I Project name: 1`" ( 0 ! ' Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 11176 S w (sru rz-i-e der M I &r(,,ew 1 04-4-vE , Rain drain connector I S.76 Sanitary sewer (no. linear ft.: ,J Page 2 Storm sewer (no. linear it: Page 2 Wrier service (no. linear R: „) Page 2 Subdivision I Lot no.: Astern or Neat: Tax map/parcel no.: Backftow presenter 31.27 >sF.lG'1lIPTtQfY QR 'WQRK Backwater valve 12.51 OUST KIT -l1 Elki &e iu K Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 t cctorshump 25.02 ei ."t0Pgs rv, OVINC '' I' : Q mt Alr IR Expansion tank 12.51 Name: M o QQ S , i`( t f}£L °I. ( L Fodtlrelaewer cap 25.02 Address: I G>2 $ U c<GO I 0 4- .A • Floor drain/floor sintdmtb - 2s.o2 rate2lP: 1 �7 Garbage disposal 25 City /S T[G e 0 0 _C(/ 2,2 Hose bib 2102 Phone: ( ) Fax: ( ) Ice maker 12.51 y < , Q.'A tirOli1' ' . ' •1:3 . cei1'1'A4"r •kesSON Intertxptor/peasc trap 25.02 Business name: Medical gas (valor $ _) Page 2 Contact name: Pruner 1251 Address: Roof drain (commercial) 1251 Sinklbasinllavatory 1 25.02 Cfty/StatefZlP: Solar wits (potable water) 62.54 Phone: ( ) I Fax :: ( ) Tub/shower/shower pan 12.51 L' -mall: urinal 2502 .. Water closet 25.02 Business name: f Q �+t C � �� Wager heater 37.52 r / , / WaterpipintliDWV 56.29 Address: 7Lf 2 5 v..0 Ft R, cr. other. 25.02 City/State/DP: - t ,,, 7 A R.') 0 e. • c1722,3 Subtotal zr, oz Phan: ( I .20 .- , Q a Fax: ( 0 ,ii_.' - i 3 5"S" Minimum pamit tee: 57250 Ta • 10 CCe Lk, .2 et 1 5 7 Plumbing Lie. no.: 34.-.2 5-7f 4., Plan review (25% of permit fee) Authorized signature: ' ri 1, it( State surcharge (12% of permit fee) ' .2. TOTAL PERMrf FEE x1.24 Print name: I ' • 6• ' !r QMi Dan 5131FAZI 7Rl a penult appIonten aspires lra parent is seabtezedMIME tall days snap'tl tars here accepted as cowpkta. albs cwthodoteay to by Th.Couniy Wdia% Service Rowaf IteuildlothmakePtlirt.41bnishApp.dge mrotma 460- 4616rti aWEB)