Permit , I CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00005
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2012
Parcel: 2S102BC08300
Jurisdiction: Tigard
Site address: 12730 SW WATKINS AVE
Project: Walters Subdivision: 2001 -023 PARTITION PLAT Lot: 1
Project Description: Replace 50' of water service and all interior water lines.
Contractor: ADVANCED PLUMBING LLC Owner: WALTERS, DONALD
PO BOX 593 12730 SW WATKINS AVE
PORTLAND, OR 97207 -0598 TIGARD, OR 97223
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PHONE: 503 - 348 -1462
PHONE: 503 -241 -4945
FAX: 360 - 571 -4188
FEES
Quantity Description Date Amount
50 If Water Service 01/11/2012 $62.54
Specifics: 1 ea Water Piping /DWV 01/11/2012 $56.29
1 12% State Surcharge - 01/11/2012 $14.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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 Notifica e er 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 qu tions to OUNf'fZy call• • 50 . 2.1987 or 1.800.332.2344.
Issued By: L✓ 4 /` PermitteeSigna.ure: , ■■•' r
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.
Advanced Plumbing LLC 3605714188 p.1
Plumbing Permit Application , . cP
Building Fixtures � �� ti��� FOR OFFICE LSE. ONLY
III City of Tigard it.,',.. 1 Received /
- Q� DateBy: I /a
� / Permit No.: del t efera -01iQ�
i 13125 SW Hall Blvd., Tigard, O ?223 \ NG �`St Plan Review
Phone: 503.718.2439 Fax: 503.598.19b0 Other Permit No.:
Inspection Line: 503.639.4175 �� ` Date/By:
T 1 G A RD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or ^ ` � , 4 Notified/Method: SupplewentalInformation
TYPE OF WORK � �y v FEE' SCHEDULE
. ❑ New construction : ❑ I)e For special irafarmarion 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 (1) bath 312.70
® 1- and 2- family dwelling El Commercial/industrial SFR (2) bath 437.78
ID Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
LI Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 12730 SW Watkins Ave Catch basin or area drain 18.76
City/State /ZIP: Tigard
Dry well, leach line, or trench drain 1 8.76
Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt. no.: or I Project name: Don and Mary Walters Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear IL: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
. Water service (no. linear ft.: 50) 1 Page 2 62.54
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 3127
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
replace waterlines same for same in home (interior)
Dishwasher 25.02
replace 50' water service Drinking fountain 25.02
Ejectors/surnp 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Don and Mary Walters Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12730 Sw watkins are
Garbage disposal 25.02
City /State /ZIP: Tigard OR 97233 Hose bib 25.02
Phone: (503)348-1462 Fax: ( ) Ice maker 12.51
❑ APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: Advanced Plumbing LLC Medical gas (value: $ ) Page 2
Contact name: ++ � 4 1-4 �(ln `' f4- / i (1� Primer 12.51
+p ` V l Roof drain (commercial) 12.51
Address: P ) 18)C r! 5q Sink/basin/lavatory 25.02
City /State /ZIP: at -Ha if.) ` qi 7 �j Solar units (potable water) 62.54
Phone. (o3) al ./ I_ t/4 (, 5 Fax :. (4,)) ' ....C. j i s' g Tub /shower /shower pan 12.51
E -mail: S ci Li) I f7 'nvitt1JcDp n� 'tt , Al 6 Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Advanced Plumbing LLC Water pipingfOWV I 56.29 56.29
Address: P.O Box 593 Other. 25.02
City/State/ZIP: Portland OR 97207 Subtotal 118.83
Phone (503) 241 -4945 / Fax: ( 8'6 5-7._._ t 1 f Minimum permit fee: $72.50
7 / / /� Plan review (25% of permit fee) •
CCB Lic: 178586 r / /Pi/ i.� Plumbing Lic. no.: pb470
State surcharge (12% of permit fee) 14.26
Authorized signature: 1 -- - TOTAL PERMIT FEE 133.09 i
4-- :
Print name: el + J• . • -.is Date: f This permit application expires if a permit is not obtained Within 180 day
after it has been accepted as complete
^Fee methodology set by Tri-County Building Industry Service Board -
T: 8uitding■PnmitslPLML '- PermitApp.doc 10101/09 440-4616T( 10/02/C01'4/WEB)