Permit CITY OF TIGARD PLUMBING PERMIT
$ COMMUNITY DEVELOPMENT Permit #: PLM2012 -00125
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/16/2012
Parcel: 2S104CD04900
Jurisdiction: Tigard
Site address: 13807 SW HILLSHIRE DR
Project: Leavitt Subdivision: HILLSHIRE ESTATES Lot: 49
Project Description: Water Heater
Contractor: COLUMBIA CONTRACTING SERVICES INC Owner: LEAVITT, THEODORE D & CAROLYN J
38197 SE HUDSON 13807, SW HILLSHIRE DR
SANDY, OR 97055 TIGARD, OR 97223
PHONE: 503 -488 -5611
HONE: 503 - 225 -0774
FAX: 503 - 668 -3701
FEES
Quantity Description Date Amount
1 ea Water Heater 05/16/2012 $37.52
Specifics: 1 12% State Surcharge - 05/16/2012 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 05/16/2012 $34.98
Type of Use: SF 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 questi o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ( t Permittee Signature: ,
e CTT l l�. —
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.
May 1512 03:57p ' Columbia Water Heaterslaa 5036683701 p.2
•
Plum bin' Permit Applieu C' EN ED
Building Fixtures
of
MAY 5 2012 FOR OFFICE t �E: U \L1
h' Tigard sad
r
13125 SW FGffi Blvd., Tigard,OR 97223 S l L 13- u l'0 K- /�(o CO l
503.639.4175
Phone: 103.639.4171 Fax s93s�ibBUIaODING FTIGABD Other
: , ; D bas ion Line Dwell
�d�agsw L DIVISION �, ,1ejr. See Page2 j for rf� So fog
TYPE OF WORK FF' SCHEDULE
' Q Tkw chess
❑ Dewsoliti� Forte Wwwweraa use cheer=
tton/ oem®t 0 Ogg Description I �- Ea Total
New 1- 2-family dwellings (includes 100 It for each utility correction)
CATEGORY OF CONSTRUCTION SFR (1) bath 24910
jand 2- 1hm dwelling ❑ SFR (2) bath 350.00
❑ Accessory '�"1 ❑ Multi-family SFR (3) bath 399.00
❑ Master builder-1 ❑ Other
Each ' ag e 2
I
JOB SITE INFORMATION AND LOCATION F°° (-- s q. 8) Page 2
Job site addtrss Site utilities
/3LQo 7 sG(� `-/ > / /s4•.e E �ie, Catch basin or area drain 16.60
City/State/21P: .7 yA D /� Drywall, leach line, or (reach drain
1660
Sttitdbldg,/apL no. I Project Footing drain (no. linear a: i) Page 2
Cross street/directio� jut site:
Manufactured home mikes _ 110.00
• Manholes 16.60
•
1 Rain drain connector 1660
Sanitary scare,* (no. linear 8:_) Page 2
Storm sewer (no. lima 8:__) P age 2
Subdivision
I Lot no.: service (no. r $: __, Page 2
Tax map/parrel nai Fixture or item -
1 , DESCRIPTION OF WORK valve
16.60
��i4i r is /- '�A%E.e_ Page 2 Backwater valve
16.60
Clothes washer
Dishwasher
16.60 _
- Y OWNER 16.60 —
1 Q 1ENANT Drinking fountain 16.60
/�bi ....e&-.4/1,-,g7— E .9....e&-.4/1,-,g7— �° 1660 MI
Name:
Address: Expansion tank
16.60
City/State/AP: Fiiocmrc/sewer 16.6° ME
Phone 15 r P Floor drain/Boorsa°, 16.60
o' $ - Fa:c ( ) Garbage dispond ME 16-6° MN
❑ AI'pucAIVT CI CONTACT PERSON
Hose bib _
Ice mane 16.60 —
maker 16.60
Business
Contact Mali:
trap 16.60 —
Address: Medical gas (value: S ) _ IMEI
City/State/7,[P 16 :
Phone" ( ) Roof dram (commercial) r 16.60
Fax : ( ) dlavatory 1660 —
E -mail:
Tub/showerIshowar pa 1111 CO XIRelCT08 �Urisa! 1660
16.60 NM
Business mama: Gtly! 4 E., _ - r 16.60 MIMI
�eftA/ . 4� r'
Address • ( 3 0 / 2 .5�— - Ma,' � :� 16.69 —
�4 Other IIIIIIIIIIIIIMIEIIIIIIIIIIIIIIIIIM
City/5tatefL1p -et -, l'e/ eAe---
e
CC.B Lie.: ( 2J - . sus e p 7 7 _4 Fax ( ) ` permit fee: 572.50 ME
o - �70
13 Ina no: .� o, la 2S%o fee: f3625
Authorized signature- �� — flan m' (ZS9b ofperm>t foe) ORM
Pint name: �� ' 1 1 I State (12%oFpemr @Eee) 7
�/ el � G ' GeJGr - � Dates /S -/,? This permit a TOTAL PERMIT FEE , • 3D
ppgdtioo 7a permit is not obtained within 9l