Permit CITY OF TIGARD PLUMBING PERMIT
• " COMMUNITY DEVELOPMENT Permit #: PLM2012 -00072
Date Issued: 03/29/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 25111AD01900
Jurisdiction: Tigard
Site address: 14580 SW 88TH AVE
Project: CHAMBERLIN Subdivision: PINEBROOK TERRACE Lot: 16
Project Description: Installing (1) electric mini - boiler.
4/3/2012: REPRINT permit to add irrigation backflow preventer.
Contractor: THE HEATING SPECIALIST INC Owner: CHAMBERLIN, GENE H
9300 NE HALSEY ST EILEEN J
PORTLAND, OR 97220 14580 SW 88TH AVE
TIGARD, OR 97223
PHONE:
PHONE: 503 - 257 -7000
FAX: 503 - 257 -7702
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/29/2012 $31.27
Specifics: 25 Misc Other Fee 03/29/2012 $25.02
1 12% State Surcharge - 03/29/2012 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 16 Additional Permit 03/29/2012 $16.21
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 503.232.198 or 1.800.332.2344.
Issued By: Xe Permlttee Signature: 61/1/ � ei./ 70"/
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.
CITY OF TIGARD PLUMBING PERMIT
_... COMMUNITY DEVELOPMENT Permit #: PLM2012 00072
T [GAR I? 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2012
Parcel: 2S 111 AD01900
Jurisdiction: Tigard
Site address: 14580 SW 88TH AVE
Project: CHAMBERLIN Subdivision: PINEBROOK TERRACE Lot: 16
Project Description: Installing (1) electric mini - boiler.
Contractor: THE HEATING SPECIALIST INC Owner: CHAMBERLIN, GENE H
9300 NE HALSEY ST EILEEN J
PORTLAND, OR 97220 14580 SW 88TH AVE
TIGARD, OR 97223
PHONE: 503 - 257 -7000 PHONE:
FAX: 503 - 257 -7702
FEES
Quantity Description Date Amount
25 Misc Other Fee 03/29/2012 $25.02
Specifics: 1 12% State Surcharge - 03/29/2012 $8.70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment - 03/29/2012 $47.48
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.
loquik
Issued By: ermittee 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.
.,te■
Mar. 29. 2012 8:42AM The Heating l ists No. 0862 P. 2
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Plumbing Permit Applica ' `� �`4
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Building Fixtures '1:\ FOR OFFICE USE ONLY
City of Tigard e PQ RCCE1 nLm� �_ 0 13125 SW Hall Blvd„ Tigard, OR 972 N % Q , S \ \JI p� Dsae/BY Review
t . o � /"... Permit No.: UVU�°T
phone: 503.718.2439 Fax: 503.598. Other Permit No.:
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T I G n It n Inspection Line: 503.639.4175 \\�Q \\V Date Ready/By: 7urig El See Page 2 for
lntemet: www.tigard or.gov t�\� Notified/Method: f�j I SvpplcmeemlInformation
• • • TYPE OF WON{ , . FEE' SCREBULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. F Ea. 1 Total
• ® Addition/alteretlonlreplacentent ❑ Other: New 1- 2- famlly dwellings (includes 100 ft. for each utility connection)
. • . CATEGORY OF CONSTRUCTION • , SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Actx building SFR (3) bath 500.32
ssory g ❑ Multi- family
• - Each additional bativkitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( S4. R) Page 2
JOB SITE. INFORMATION' AND,: LOCATION' , Site utilities:
Job site address: 14580 SW 88° Ave Catch basin or area drain 18.76
City/Stale/ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.:._) Page 2
Suite/bldgJapt. no.: I Project name:3024.K r kf. L r■N
Manufactured home utilities 50.03
Cross sired /directions to Job site: Manholes 18.76
Main drain connector 18.76
e , e Sanitary sewer (no. linear IL: Page 2
Storm sewer (no. linear ft.: ,___) Page 2
s r Water service (no. linear ft.: -� Page 2
Subdivision: Fixture or item:
Tax map/parcel no.: Backflow preventer 31,27
DESCRIPTION r Backwater valve 12.51
Clothes washer 25.02
Install Electric Mini-Boiler/Radiant System
Dishwasher 25.02
Drinking fountain 25,02
Ejectors/sump 25.02
PROPERTY a Expansion tank 12.51
• Fixture/sewer cap 25.02
Name: Gene Chamberlain
Floor drain/floor sink/hub 25.02
Address: 14580 SW 88th - -
Garbage disposal 25.02
t ' OR Hose bib 25.02
(503)639-6897 Ice maker 12.51
It". APPLICANT ❑ CONTACT PERSON interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Rod (commercial) 12.51
Address: Sink/basin/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
.. CONTRACTOR - Witter closet 25.02 -
1 Water heater 37.52
Business name: The Heating Specialist Water piping/DWV 56.29
• Address: 9300 NE Halsey SI, Other: Mini- Boller 1 25.02 25.02
City/State/ZIP: Portland, OR 97220 Subtotal 25.02
Phone: (503) 257 -7000 Fax: ( ) Minimum permit fee: $72.50 72.50
Plan review (25% of permit fee)
CCB Lic.: 56628 \ 1 . lumbing Lic. no.:
State surcharge (12% of permit fee) 8.70
Authorized signatu , • , . X 111 TOTAL PERMIT FEE 81.20
rPrint name: Tracy Jones C I Date: 03/28/12 I This permit application expires ;Ca permit to not obtained within ISO Jeri
after it bait been accepted as complete.
Mice methodology set by Tri -County Building Industry Service Board.
1:\B,uldint∎Pc(MTLAP MU.PermliApp.doc 10/01/09 440- 4616T(I0/62/COMJWE5)