Permit CITY OF TIGARD PLUMBING PERMIT
7 - COMMUNITY DEVELOPMENT Permit #: PLM2011 -00177
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2011
Parcel: 2S103CD07100
Jurisdiction: Tigard
Site address: 13890 SW 118TH CT
Project: Grover Subdivision: CREEKSIDE PARK Lot: 2
Project Description: Kitchen remodel, replace sink, dishwasher and ice maker.
Contractor: MODERN PLUMBING Owner: GROVER, JERRY AND JUDY M
11120 SW INDUSTRIAL WAY 13890 SW 118TH CT
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 691 -6166 PHONE.
FAX: 503 - 691 -6771
FEES
Quantity Description Date Amount
1 ea Dishwasher 06/07/2011 $25.02
Specifics: 1 ea Ice Maker 06/07/2011 $12.51
1 ea Sink 06/07/2011 $25.02
Type of Use: SF 1 12% State Surcharge - 06/07/2011 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 06/07/2011 $9.95
Plumbing
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 Not ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire questions to OUNC by - allin. 503.232.1987 or 1.800.332.2344.
Iss .• dBy: /, Permittee Sign: )
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.
Jun. 6. 2011 3:35PM Modern Plumbing No. 8811 P. 1
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Building Fixtures EI I ' iglu older', usr: °Ni. '
111 City of Tigard JUN 7 2011 Received Permit No
D ate/B CP� . CN�oi! -Dc'7
., • 13 125 SW Hall Blvd„ Tigard, OR 97223 plan Review
I • - Phone: 503.718.2439 Fax: 503.598496 Other Permit No.:
Inspection Line: 503.639.4175 t-1 Y OF TI CARD Date R e
TIC AR n, w g �� N a tfi d /Methy J See P
Internet: ww ,tigard -or. ov Ions ee en t: l for
: +� •w+'�'n,,,.�...,w,.,,,,.., ,,.,., Supplemental BUILDING DIVISION o i e ne' s
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0 New construction ['Demolition ' For special informalion use c_hecklis,
[ 'Addition/alteration/replacement ❑Other: De sOr'ptio n I Qty. I Ea I Total
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
, ;��2 , & '�;���5 �h't, d p� �[ -ray "`' ";i s + SFR 6
%� \p��,
r'. . .. .., i�:.•'r 3.. - e. 1•-v ti 9J'!• .�i '„Y '
�i ) '• �1�} " "�: <i..: ( / ."" -
`> ,r , +:., r ;g..: ^ 312.70
9, 1- and 2- family dwelling 0 Commercial /industrial SFR (2) bath 437,78
0 Accessory building ❑ Multi- family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
El Other;
g e 1 v :n' C� (�, ,, Fire sprinkler ( s9 fl.) Page 2
T s ;s ; aY F4 t 'T 9nnw i, e' �fn P '�6 lti Y 1 , 1�:' ;'1' � ,\ F� Site utilities:
Job site ad O s // �,�, Catch basin or area drain 18.76
dress;
-
City /SCatc/Z1P: r Q 1 1 7 4 Drywall, leach line, or trench drain 18.76
'�` Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /opt, no.: Project name:
s '7" 0 ✓e-e- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1 14.. A r Rain drain connector 18.76 _
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.; _J Page 2
Water service (no. linear ft.; __) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
'` o'N y ' t C �7\ i v v yyia� a >.... ,, 'i ryMC � a �',�,r , 9 yru i ^ INYtt ,� s.i (Backwater valve .�
, nif?„ A :4, ' y \:, .` C•,'r.-,t' ,`t .rl.r. n G cttL
v. s'. �,y, 4 iV3A , ` ' c 12.51
i clothes washer 25.02
Ar.��:d -ii. -/ 1 i'�t""' 1' Dishwasher J. 25.02 ?S-'b)
- r✓o 4 _ Drinking fountain 25.02
Ejectors /sump 25.02 f
a RP ti.
. b a tt ` n, i} lm' y ' s Sl '- .. s )
` ., Expansion tank (, _
LL.., � - WV,..,,, .� 1 A �. , -.:44:0,41z::1!4', ! e � ca. 0,, r,r ,.:m ,4 � i . . „=,.a, ` P 12.51
Name: Fixture /sewer cap 25.02
Floor drain /floor sinkAmb
Address: 25.02
City /StAtcJZIP: Garbage disposal 25.02
maker bib 25,02
Phone: ( ) Fax
( ) ice ker I 12.51 12 fi 1
' :,, !1 �': • t 4' k� u \ s''-g Ps � i �-i , a , y a,a lnterce todgreaSO trap 5,02 • t��, ia, Ice. . -.r ;'m, ;.r9� ) 14,: „ „�+s;, rte ,; P 2
Business name: Medical gas (value: $ ) Page 2
Contact name: - Primer 12.51
Roof drain (commercial) 12,51
Address:
• Sink/basin/lavatory I 25.02 ,) SDI
City /StatelZlP: Solar units (potable water) .. 62.54
Phone: ( ) Fax:: ( ) Tub /shower /shower pan 12.51
E -mail; - Urinal r-� T 25.02
'i:'
`Z'` uOt':p,' : ; ' ' 'rid \S: - ' 'rl : . '?7'. ' ∎::
'. � : ''y :; a'/, ��{.r �. :. :.., Water closet 25.02
. ." tr4,�y;i'1'k.;T :R.tt a \�';. ,C�ti'i.' �;1._d . �Ly l,. , k j ,, a i " .,:iI, ', :',' ' <y? " )Ej
,r�r 4- w' °,- ,..'�.�:,:, ,. �, .v�.,.?Y.K:, :.,�I ::ri�a. ,.::,I!r " �rf r,,.:1! ' ,.tr
'' Wstcr heater 37.52
Business name: II , r a i ! ../ 4 ,� /4 / Li Water piping/DWV 56.29
Address: / v )
�/ = . , Other; . 25.0
City /State/ZIP; -rczr, l A a� O1 q.1o6� Subtotal &2 5 - 3 -
p_hoil j2 ( l0 ` kk F ax : ( ! _(' ! 6 71L ^ Minimum permit fez; $72.50 '7? SC
CCB Lie.; j 7 I C c, Plumbing Lie, no.: •iij -N Plan review (25% of permit fee)
State surcharge (12% of permit fee) K7
Authorized signature
'� - ' ii r -.L._ -.L TOTAL PERMIT FEE f /. � p
- Print name: (/?/ A l , , , a j, a Date; This permit application expires if a permit is not obtained within 180 doy8
r , l • after it has been necepted as complete. �b - - J
*Fee methodology set by Tri- County Building Industry Service Board,
IABuilding1Permiis1PLbiU- PennilApp.doe 10191/09 440 4616T(I0/02 /COMfW1EB)