Permit CITY OF TIGARD PLUMBING PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00376
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2011
Parcel: 25111 DD06800
Jurisdiction: Tigard
Site address: 15735 SW 88TH AVE
Project: RUBOTTOM Subdivision: STRATFORD Lot: 65
Project Description: Kitchen remodel.
Contractor: ACCURATE PLUMBING & HVAC LLC Owner: RUBOTTOM, GRAYDEN A & DEBORAH L
3021 NE 72ND DR #924 15735 SW 88TH AVE
VANCOUVER, WA 98661 TIGARD, OR 97224
PHONE: 360 - 944 -8952 PHONE:
FAX: 360- 896 -4870
FEES
Quantity Description Date Amount
1 ea Dishwasher 12/20/2011 $25.02
Specifics: 1 ea Garbage Disposal 12/20/2011 $25.02
1 ea Ice Maker 12/20/2011 $12.51
Type of Use: SF 1 ea Sink 12/20/2011 $25.02
Class of Work: ALT 1 12% State Surcharge - 12/20/2011 $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 Ann 332 2344.
r �
Issued By: `ermittee Signature:
Call 50 .639 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.
Dec 19 11 01:13p Allan Ellerman Accurate P 3606045944 p.2
Plumbing Permit Application
Building Fixtures RECEVE I FOR OFFICE LSE ON ,A
City of Tigard Received 1 Q
Permit 4, g Date/By: � ' "1 1� ,p / _ (I Yt
1111
a 13125 SW Hall Blvd., Tigard, OR 97223 1111 9 2011 e YTf - �r'£` ip� l.l! 37G
0 :. P hone: 503.718.2439 Fax: 503. 598.1960
Plan Review
Date/By: Other Permit No.:
D
TICAR Inspection Line: 503.639.4175
Internet: www.tigard -acgov BUILDING BUCt CITY OF TIGAR II Date Ready / By: tuns la See Page 2 for
ILDII iG DIVISI,! ; tified/Method: 0 Supplemental Information
TYPE OF WORK iJ FEE* SCHEDULE
f] New construction ❑ Demolition For special information use checklist.
Description I Qly. I Ea. ( Total
Additiotvaltcration/replacemeni ❑ Other: New 1- 2- family dwellings (includes 100 fr. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
V 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /5 - < - / �► '/� Catch basin or area drain 18.76
J '� `� Drywell. leach line, or trench drain 18.76
City /State2 CP: -/ 7a ,1- . i) 42/e-- 72 2-4
Footing drain (no, linear ft.: �) Page 2
Suite/bldg./apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
a
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 prey enter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�j Clothes washer 25.02
�G4?et" / 1) M )/
/ S POc - .c -t Jet Dishwasher / 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT • Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal / 25.02
City. /State/Z1P: Hose bib 25.02 •
Phone: ( ) Fax: ( ) Ice maker / 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name:
Primer 12.51 '
Roof drain (commercial) 12.51
Address: Sinl:fbasin/lavatory / 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51
E -mail; Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: X l J�tl�rT� /J /B ��a �� GG6 Water ! m DWV 56.29
f` �" y, / P�P� �
Address: ' c , Z / rt. ?z .2)12 ,1 ; 6 .z - 1 ( - - Other. 25.02
City /Slate /ZIP: ��li/c6r_ i, ,,,ter ix ,41.. o 6 / Subtotal 9'
Phone: ( 360) 9 � 4 . " - : , 5 2 - 7 S v Fax: ( ) F9e, ',c 7e Minimum permit fee: $72.50 y 7
� Plan review (25% of permit fee)
CCB Lic.:
/ 90 7:00/0002 Plumbing Lie. no.: pfj 9 State surcharge (12% of permit feel /O
Authorized signature: ��-� -
�shw r ,. ... 2 . - TOTAL PERMIT FEE ��e)
i This permit application expires if a permit is not obtained within 180 days
Print name:
�� ��� Date: / z // �/ I after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
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