Permit PLUMBING PERMIT
111111 CITY OF TIGARD
- COMMUNITY DEVELOPMENT Permit #: PLM2009 -00269
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/29/2009
Parcel: 2S110BA04500
Jurisdiction: Tigard
Site address: 14335 SW MCFARLAND BLVD
Subdivision: Lot: 0
Project: Fujitani
Project Description: Replace shower valve.
Owner. FEES
FUJITANI, FRANK AND JANET Quantity Description Date Amount
14335 SW MCFARLAND BLVD
TIGARD, OR 97224 1 ea Tub /Shower /Shower Pan 09/29/2009 $16.60
PHONE: 1 12% State Surcharge - 09/29/2009 $8.70
Plumbing
56 ea Minimum Fee Adjustment - 09/29/2009 $55.90
Contractor: Plumbing
MILWAUKIE PLUMBING CO
PO BOX 393
CLACKAMAS, OR 97015
PHONE: 503 -655 -9161
FAX: 503 -655 -1726
Type of Use: SF
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: ,q Permittee Signature: e-", z _ / c' -77 /
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day. ��/ VVV
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.
.From: 09/25/2009 16:45 11923 P.002/002
Plumbing Permit Application c
Building Fixtures rcpt. (iFrtc r ('sr. : 0.t.v
SEP 26 7009
1 ` ' w Blvd, Tigard, oR ` z h D 99'009 " tiro; ) "1,2709 G,a,6?
C Phone: 503.639.4171 FOE 50339 i � F TIGARD a>as P� No.:
Inspection Line: 503.639.4175 li 0 / �finn _ ! ' ' : y
T : I G A R I) WtD is ! .. , g/g1: ties I>S See Page 2 for
Internet www.ttgIrd•oLgov „
i3,U1LDIN� nN1Sl � `� r/ Supplemental Information (
iTYP6: oF : l `
, t
=FEE.
SCHEDULE
❑ New construction ❑ Demolition For speciaiulfonnatian sue cheekfec
Addifion/alteratioa/ tau ement 0 Desorption ' Q<Y. I Ea. ' Total
mP New 1- 2 -family dweffings (includes 100 0. foreach utility connection) .
CATEGORY: OF: CONSTRUCTION': . SFR (1) bath 249.20
Z1.1- and 2- family dwelling ❑ Commercial/ industrial SFR (2) bath 350.00
❑ Accessory beading ❑ Multi- family SFR (3) bath 399.00
. Each additionalbath/kitchen 45.00
❑ Master builder ❑ Other- Fire .
sq. ) Page ag 2 •
. . _ . :JOB SITE INIF'ORMATION AND LOCATION ...
1 0. bA? M F i r10( Ca basi
lob site address: �, �+ Catcb,ha.4in or area drain 16.60
City /State/ZIP: i (: ('I /� ('� 4 O o a (_j . .` Dowell, leach line, or drain 16.60
Suite/bldg./apt. no.: _- '` Pmojoct name: 44 a(�� 4 V t � I ' Footing.d (no. linear 0.: _ j Page 2_ y Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ___) Page 2
Storm sewer (no linear>i :.� Page 2
Subdivision: I Lot no ": Water service (no. linear 8.: ) Page 2
Tax map /parcel no.:
Fiatme or Item
Absorption valve 16.60
p `/� j, DESCRIPTION � OF � WORK:: . : Bad�owpmvemer Paget
C.Q SOCQ ' A � /L Vii OUR Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPtTY. OWNER ;i y ` ... O � T , E - N _ ANT : : ` - °linking fmmlain 16.60
Name: c arc V , -i- Z� l/i UL%l F `i curt k.. � on tank 16.60 .
Address: v Fixture/sewer
cap 16.60
City/ State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax ( ) Garbage diaposal 16.60
is t;',: : : ; :;: :APPLICANT' <:; ; ' • ' •. ❑ CONTACT PERSON : Hose bib 16.60
Business name: 1 n,� maker 16.60
V 1 `Q 9 \\}. imb) ,� ' ' "��y \ � I pLOrlI��p 16.60
Contact name: (lj V Medical gas (value: S ) Page 2
To Address: Prima 16.60
City/State/Z C \ (� /ti _m(� [∎ -- Roof drain (commercial) 16.60
Phone: ) ���,e;5169 k i7r i•r Fax : (�C��1 �C J-,a� Sink/basin/lavatory _ 16.60
r
Tub/shower/shower t 16.60 l (.0,U) E l / .1 mp ckiveniirv corm urinal 16.60
.:: Y : :: • : ; ` . CONTRACTOR
- :..:. ` ":. Water doses 16.60
Business mune: in P c 'It r iyyl b y ‘5 CO Water heater 16.60
Address: i ?() 1 j Other. •
City/State/ZIP: (I k=.axecI n O5 Gl _CSI 5 Subtotal It of tnC) fee: $7150
Minimum ,Phone: ( Far r Residential bac/dime minimum permit fee: $36.25 / � l ohs --C � i o � � td�s 1 - 7 a Pl. permit �a � _
V
CCB Lie.: �a7a- Plumbing Lie. no.: an review (25%ofpermit fee)
•
I � Stale surcharge (12%of permit foe 11
Authorized signature: 1 �
- - `� .- - TOTAL PERMIT FEE si
Print name: C , Date: P W�� This permit application expires if a permit is not obtained within
t C r 5;'i ��► l M iim / /�%� ISO days alter It has been accepted as complete
•