Permit CITY OF TIGARD PLUMBING PERMIT
: • COMMUNITY DEVELOPMENT Permit #: PLM2011 -00332
Date Issued: 11/03/2011
"TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Parcel: 2S1046A06400
Jurisdiction: Tigard
Site address: 13863 SW NORTHVIEW DR
Project: SULLIVAN Subdivision: CASTLE HILL NO.2 Lot: 97
Project Description: Kitchen remodel.
Contractor: ACCURATE PLUMBING & HVAC LLC Owner: SULLIVAN, PATRICK J & DENISE L
3021 NE 72ND DR #924 13863 SW NORTHVIEW DR
VANCOUVER, WA 98661 TIGARD, OR 97223
PHONE. 360- 944 -8952 PHONE:
FAX: 360 - 896 -4870
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 11/03/2011 $25.02
Specifics: 1 ea Garbage Disposal 11/03/2011 $25 02
1 ea Ice Maker 11/03/2011 $12 51
Type of Use: SF 1 ea Sink 11/03/2011 $25 02
Class of Work: ALT 1 12% State Surcharge - 11/03/2011 $10 51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $98.08
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: c am. Permittee Signature:
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.
Plumbing Permit ApplicaCEW
Building Fixtures 1v0V 0 3 2011 FOR OFF1cE . USE ONLY
City of Tiga1 d RD n +�B . � I1/ 3 h PermitNo.: �u i),),....(22,-.3)._
a 13125 SW Hall Blvd., Tigard, OOF TI OA
I Phone: 503 718 2439 Fax � NG DIVISION Pia° Review
Date/By: n Re Other Permit No
TI GAR Q Inspection Lme: 503 639 4175116 pate Ready - lusts El Sec Page 2 for
Internet www.tlgr'd- or.gov Nou(cLMcthod: Suppkmental Information
TYPE OF WORK FEE" SCHEDULE
❑ New construction ID Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition /alteration/replacement ['Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(11 bath 312.70
d 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building El Multi-family SIR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder Cl Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address. /3 16,, �� 0 r ��K� � Catch basin or area drain 18.76
�T Dry well, leach line, or trench drain 18.76
City /State/Z.IP: 7 -,,, , a,6 40 ,, o_ ��
7 3 Footing drain (no. linear ft.: ) Page 2
Suitarbldg. /apt. no.: 1 Project name: g Ill uciI Manufactured home utilities 50.03
Cross streelidireetions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no linear ft.: _) Page 2
Storm sewer (no. linear ft : „ Page 2
Water service (no. linear ft.• ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/� Clothes washer 25.02
15 r e I X A.dX.‘ Dishwasher ` 25.02
Drinking fountain ( 25.02
M v 1<,,- / 47, / .✓ , Ejectors /sump 25.02
❑ PROPERTY OWNER El T NANT' Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal / 25.02
CitytStatc /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) ice maker / 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ 1 Page 2
Pri 12.51
Contact name:
Roof drain (commercial) 12.51
Address: / 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
CONTRACTOR
Water heater 37.52
Business name' Al�7/(4 j / Var,4" "%f� J ‘.-1,---C--- Waterp:ping/DWV 56.29
Address: ;(jx/ /V' ,p, _. ?2 _ j ' Other: 25.02
City /State/ZIP: 6// 6t),4t- ',/' Subtotal f•7 S
Minimum permit fee $72.50
Phone: (5,/.0) 9� y`�SZ -� Fax: ( "40 ) ,.5'7 ���G � - - --
Plan review (25% of permit fee)
CCB Lie.: /7 E Plumbing Lie, no_: 5.;e2 5.;e2 40P "" State surcharge (12% of permit fee) /0.57
�/�• / /11 t
Authorized signature: d � � e -,-' TOTAL PERMIT FEE' _ 5.08/
Print name: 2`.4.�r1 ���,e -�% Date: 0 f/ //
This permit application expires if a permit is nut obtained r ilLiia 180 days
after it has been accepted as complete.
*Fee methodology set by Tri - County Building Industry Service Board
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