Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00031
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2012
Parcel: 2S 108AB05000
Jurisdiction: Tigard
Site address: 14051 SW 155TH TER
Project: SMART Subdivision: BRENTWOOD ESTATES Lot: 12
Project Description: Water heater replacement.
Contractor: CROWN PLUMBING Owner: SMART, JERI
5429 SE FRANCIS ST 14051 SW 155TH TER
PORTLAND, OR 97206 TIGARD, OR 97224
PHONE: 503 - 504 -4997
HONE: 503 - 771 -9449
FAX: 503 - 771 -9454
FEES
Quantity Description Date Amount
1 ea Water Heater 02/14/2012 $37.52
Specifics: 1 12% State Surcharge - 02/14/2012 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment - 02/14/2012 $34.98
Plumbing
Class of Work: ALT
Type of Const:
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 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: / - 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.
01/01/2007 01:01 5037719454 i ce's:, CROWN PLUMBING PAGE 01/02
■ Plumbin Permit A lies , ,�� `
Site Utilities "
01
114 4 City of Tigard ff ,� Remind 13125 SW Hall I3Jvd,, Tigard. OR 9722 �� C DatdB : b I 1 Permit Na: AM� d /)--0007 i
C Phone; 503.71R.2439 Pax; 503.598. 95q °�`- Plan Review
Ina ction Line: 503.639,4175 CA' ' t �� Date/ay; Other Permit No.: T'ISiAR. _
Intern Pa ; .., . ,. , et: www
. tigard or
��� Date Rea y�g� Notiree `
i'y � ■�i� Supplemental Information
0 New construction • � , �. - 'i:„.,
❑ Demolition For ertat in , rmatton use checklist `
Dcscri 'on
.
Addition /alteration /top's Ea
IN
gs (includes 100 R Total
. -: >,; ;: ;-'.: :� ., i ' ^:. `..:�': - - .far each utility connection)
lacement ❑
,. c:: ; ..... tigGegii+. itF);'�
Other:
,.. � ,- :..., .. ;, ;,, .. 1 2 fan
New 11y dwcllirA
Y g ❑ Cotnmcr ,.. SFR (I) bath 332.70
1- and 2 =fhm il dwellin al /industrial SFR (2) bath 437,78
0 Accessory building ❑ Mufti- family 5FR (3) bath 500.32
❑ Master builder Each additional bath/kitchen ------ 25 02
❑ Other:
Fire sprinkler (� sq. R.) Pa
:tO ' tr* , ' Gf2V: J 1* jONNP Slte utilities: - 2
•Tob site address: Catch basin or area drain 18.76
Qr
City/State/ZIP: a 3 7 Drywall, leach line, or trench drain 18.76
C r jrty . ... -
Suite/bldg. /apt. no.: Project name: - Footing drain (no, linear f1.: ) Page 2
Manulctured home utilities 50.03
Cross street/directions to job site: W Manholes
18.76
Rain drain connector 18.76
- Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no, linear IL! _) Page 2
Subdivision; Water service (no, linear ft.: ___,) Page 2
1 IAt no.: Fixture nr item:
Tax map/parcel no.:
Backtlow prcventcr 31.27
-
1d 'r. ai 5 , r _n F ' Xr - Backwater valve 1.2.51
o 3 w t v_ , / -� Clothes washer W 25.(12
e:', Dishwasher 25.02
-_ Drinking fountain 25.02
Ejectors/sump ` 25.02
'' 'Tito Expansion tank E
'.. 12.51
...
Name: t?Ir i 5 Ylt c1t r 1- Fixture/sewer cap _^ 25.02
Address; Floor drain /floor sink/hub 25.02
/5
✓ v c -g, Garbage dis oral
City/State/ZIP: r ^,, 0 • • 7 �.-- p 25,02
Phone; (ja) T rose bib �� 25.02
�_. .� maker Fax: ( ) f ee ekcr • :b fi,I'1 ,.3,0011. 15.0 t
-
. � � : ' ' '�' 1'C�ltiti,",1' 'i?"�iR�N'of" Interceptor /Srnase trap 25.02
Easiness narnc: lv f eY pr ►S P y, h C r] _ Medical gas (value; $ ) p� 2
Contact name; Z t7 yv 1 S I k 5 Primer 1.2,
Address: • - Roof drain (commercial) 12.51
City /State/21 P:
Sink/basin/lavatory 25.02
Solar units (potable water) 62.54
Phone: ( ) Fax : ( ) Tub/shower /shower pan _ _ 12.51 -
E-mail: e. fV 0 k J c r nl 5 C ' 9 Urinal 25.02
water
'L LW� I, , .. . .' closet 25.02
VOW
...:.., Water heater
Busine n ame: N 1 37.52 7 r 5.. 2.
--- -� water - +
� '- `'•
Address:
Sti zq 5I f l tiv e l 4 s •1 Other; 25.02
City /State/7.TP: d r e., J, f 0 7 0 (,
Phone: Subtotal , 37, 5: ( 5 7 7)3) 771- 99y Fax ;�0 ) /- • 4/..5 Minimum' permit fee: $72.50 7a , 5"0
CCB Lie.; f7 3 / /7 3 Plumbing Lie. no.:� 7/1/7 _ Plan review (25% of permit the)
Authorized signature: /1/1nx�� ¢ State surcharge (12%1, of permit fee) Fri 0
- - TOTAL PERMIT FEE Vf
Print: name: yq . •'t M et.0 f to Date: - / p •- f 2.. This pent nppi eatinn expires if a permit Is not nMmincd within 150 days
after it has been accepted as compicte.
Wee methodology set by Tri- Connty Building lndiis ry Service hoard,
t:1 DaiIdinglre ,,,,;i,\PLMtmsmitApp,4oc lao1ro9 • 440,16 mm2 /COM/WER)
9 f .4 tc 5 e I C 13cn -e P tr 141' *