Permit CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00301
Date Issued: 10/05/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel: 1 S133DD13800
Jurisdiction: Tigard
Site address: 11952 SW 127TH PL
Project: SCHMITT Subdivision:9LLAGE AT SUMMER LAKE PARK NO. Lot: 175
Project Description: Bathroom remodel
Contractor: MODERN PLUMBING Owner: SCHMITT, LORI KAY
11120 SW INDUSTRIAL WAY 11952 SW 127TH PL
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE 503 - 691 -6166 PHONE
FAX. 503 - 691 -6771
FEES
Quantity Description Date Amount
2 ea Sink 10/05/2011 $50.04
Specifics: 2 ea Tub /Shower /Shower Pan 10/05/2011 $25.02
1 ea Water Closet 10/05/2011 $25.02
Type of Use: SF 1 12% State Surcharge - 10/05/2011 $12 01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 ..800 332 344
`-"
Issued By: - ermittee Signature:
/�
Call 503.• 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.
Oct. 4.' 2011 5:24PM Modern Plumbing No. 1760 P. 2/2
Plumbing Permit Application
Building Fixtures RCEIV FOlk or I'ICI; USE ONLY .
City lar
of Ti gar R eceived
III g Date/By // 5 // 6>/) - Permii No.: /Lin av/ / i ' C) I
n 13125 SW Hall Blvd., Tigard, OR 97 3T n 5 2011 Ptah Review
• 12 Phone: 503.639.4171 Fax: 503.59 U0 V Other Permit No.:
Inspection Line: 503.639 4175 r7gtd[3y.
Ti l.i A It D Dale Ready/By: luri Fli See Page 2 for
'Memel: www.ligard- or.gov CITY OF TI( :�D GA1 NOtified/Medlod: Supplemental Information
TYPE OF DING U)����G�j FEE" SCHEDULE
CI New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
01 • i di ti0n/alte rot ion/ rep 10ceme01 ❑ Other; New 1- 2- family dwellings (includes 10011. for each many connection)
CATEGORY OF CONSI•RUCTION SFR (1) bath 312.70
®1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building I=1 Multi-family
Each additional baih/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler (_ sr{, lI,) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I 1 ef S 3 tJ I -' ' • r L QC , Catch basin or area drain 18.76
Drywell, leach line, or Trench drain 18.76
City /9iate2lP:
t 1 era W I - X) 1 Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: I Project name: ■ Manufactured home utilities 50.03
Cross stredt/direclions to Job site. Manholes 18.76
-,..5 I: S 4 Rain drain connector 18.76
Sanitary sewer (no. linear II.: ___) Page 2
Stone sewer (no, linear R,: ) Page 2
Water service (no. linear (1.: ^) Page 2
Subdivision: I Lot Ito,: Fixture or lent:
Tax mop /parcel no,; Backflow preventer 31.27
DESCRIPTION OF WORK Ddelnvaier valve 12.51
� l/ Clothes 'washer 25.02
/ // r .A�l ' ` ∎1 A 1, l l _ w Dishwasher 25.02
1 "41 6 tl 'eti.- VI Drinking fountain 25.02
Ejectors/sump 25.02 -
❑ PROPERTY OWNER ❑TENANT Expansion lank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sinkflnib 25.02
Address:
Garbage disposal 25,02
City /Slatc/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON lnlcrceptor /grease trap 25,02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 1151
Address:
Sink/basin/lavatory 2 25.02 9)C)'
City /Slatc/ZIP: Solar units (potable water) 62,54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 2 12,51 ,i) st,a
E-mail: Urinal 25.02
CONTRACTOR OIt - Water closet / 25.02 ,),51?)
Water heater 37,52
Business name: 01 0 8 p U Y-vt to 1 Water piping/DWV 56.29
Address: 1 l { t '2- C> 5 tr) . yk. ciuS .4-y- ;_e., I Uj4.q Other: 25.02
City/Stale/ZIP: 'T & _L (1,4 1 , t --, Q Cl '7 0 E..)--_ / Subtotal /00 0 $
Phone: (cDJ �q 1 (( f Fa ( a)3 I 1 / -ii 1 Minimum print fee: $72.50
CCB Lie.: + c 1 � Plumbing Lie. no.34 I a O "e
review (25% o of fee)
Authorized signal; ` +
Au State surcharge (12% of permit Fee) /..7 p
' L . - / 1 , • TOTAL PERMIT FEE / b D 1
Print nam. Y4 ` r V �1 This permit application expires If a permit is not obtained within 180 days
. •� r 1 � y. 1 after it has been accepted as complete.
`"-C t Dote! r (�' 'Fee methodology set by Tri- County Building Industry Services Board.
1. 11luildingwermilAPLMU- PormlIAppdoe IIVOI/09 940- 46167(10102/COM/WLB)