Permit CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit #: PLM2012 -00133
T t G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 2S104DB02500
Jurisdiction: Tigard
Site address: 13133 SW ROCKINGHAM DR
Project: Dicken Subdivision: AMESBURY HEIGHTS Lot: 25
Project Description: (1) lavatory, (1) shower pan, (1) water closet bath update
REPRINT 6/25/12 (1) shower pan, (1) water closet and (1) lavatory for another bathroom if.
Contractor: ACCURATE PLUMBING & HVAC LLC Owner: DICKEN, KEVIN R & ANN T
3021 NE 72ND DR #924 13133 SW ROCKINGHAM DR
VANCOUVER, WA 98661 TIGARD, OR 97223
PHONE: 360 - 944 -8952 PHONE:
FAX: 360 - 896 -4870
FEES
Quantity Description Date Amount
1 ea Lavatories 05/23/2012 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 05/23/2012 $12.51
1 ea Water Closet 05/23/2012 $25.02
Type of Use: SF 1 12% State Surcharge - 05/23/2012 $8.70
Class of Work: ADU Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 05/23/2012 $9.95
Plumbing
Occupancy Grp:
,[ 1 ea Lavatories 06/25/2012 $25.02
Stories: /_ 1 ea Tub /Shower /Shower Pan 06/25/2012 $12.51
K 1 ea Water Closet 06/25/2012 $25.02
Total $143.75
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: A (�j f // „ 4 Permittee Signature: A 1 L/ C4 i I Q r 1
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 -00133
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 2S104DB02500
Jurisdiction: Tigard
Site address: 13133 SW ROCKINGHAM DR
Project: Dicken Subdivision: AMESBURY HEIGHTS Lot: 25
Project Description: (1) lavatory, (1) shower pan, (1) water closet bath update
Contractor: ACCURATE PLUMBING & HVAC LLC Owner: DICKEN, KEVIN R & ANN T
3021 NE 72ND DR #924 13133 SW ROCKINGHAM DR
VANCOUVER, WA 98661 TIGARD, OR 97223
PHONE: 360 - 944 -8952 PHONE:
FAX: 360- 896 -4870
FEES
Quantity Description Date Amount
1 ea Lavatories 05/23/2012 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 05/23/2012 $12.51
' 1 ea Water Closet 05/23/2012 $25.02
Type of Use: SF 1 12% State Surcharge - 05/23/2012 $8.70
Class of Work: ADU Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 05/23/2012 $9.95
Occupancy Grp: Plumbing
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. d (-.47777^ ,/� n
Issued By: Permittee Signature: Ott 4PA. ( •
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.
•
Plumbing Permit A D
Building Fixtures soli orrlcl_ t sr o \1.1
Ci of Tigard JUN Received
Ty g 2 01 2 Date/9y: to I a-5 19- sr" Pctnit No.: PUL4 0.01.1 - D DI 3
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2439 Fax: 503.01 F TiGARD
Plan Review Dates: other Permit No.:
T 1 Ci A R D Inspection Line: 503.639.4175 Bl1 , DIVISION mate Ready/By: ," - • 21 ,See Page 2 for
Internet: tvw�r_tigard or.gov l:otified/Method: � O Supplemental Informat
TYPE OF WORK FEE' SCHEDULE
❑ New construction ❑ Demolition For sperlal utfon olion ace rheeliuiiL
Description I Qty. I Ea. I Total
cddition/alteration/replacement El Other . New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
46-r and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: x3133 Ste /�OC��/ IL Catch basin or area dram 18.76
City/State/ZIP: Drywell, leach line, or trench drain 1 8.76
it...-it ; ?7 n 97 Z Footing drain (no. linear ft.: _) Page 2
Suiteibldgiapt. no.: I Project name: Manufachued home utilities 50.03
Cross street/directions to job sitc: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear R: ) Page 2
Water service (no. linear ft.:, ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�
A � h � - Clothes washer 25.02
ff tl .�� JX77! /275 Z K Dishwasher 25.02
l e- - , "4/92..,- - CO / 33 Drinking fountain 25.02
/-o0/1 0 /a 77/, 56' 7-exouiy Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roofdrain (c cial) 12.51
Address:
Sink/$ - avato / 25.02
CitylState/Z1P: Solar units (potable w ) 62.54 ,
Phone: ( ) i Fax:: ( ) Tub/shower ewer / 12.51
E-mail: Urinal 25.02
Water closet / 25.02
CONTRACTOR
Business narne:dievez,�Q°/#T��r//l7 /04-► ���e/ d L G Water heater 37.52
Water piping/DWV 56.29
Address: 302. / NO- 77 gyp. '0'9'244 to Other: 25.02
City /State/ZiP: 1��, r ,ic e3 " a ✓e/c._, A -PGl subtotal
Phone: ( 360) f f< YS$ I Fax: ( w .- / ' 7 a Minimum permit fee: $72.50 ,
B Lic.: / � iunbirtg Lic. no.: 7,5 9d 3 Plan review (25% of permit fee)
�C / 90 7
State surcharge (12% of permit fee)
Authorized signature: i ` jj TOTAL PERMIT FEB: ( $S
Print name: Ly - /e' E� �JsJ - Date• a��2_ t This permit application expires ifs permit is not obtained within 180 days
after it has been accepted =complete.
"Fee methodology set by Tti- County Brnldine Industry Service Bond.
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Plumbing Permit Applicati C II/
Building Fixtures roll oFFlcl I; I; ONLY
MAY 2 3 2012
City of Tigard Received
Date/By: SIa3 )1 l< Permit No.: pm o %a- 00133
a 13125 SW p
Hall Blvd., Tigard, OR 97� n n, „ �
II
C Phone: 503.718.2439 Fax: 503. _' I !!� OF ? + n' t D Plan e Review Other Permit No.: •
T I G n It p Inspection Line: 503.639.4175 , E i9 @L'J !��! }�' Date Ready/By: runs WI See Page 2 for
Internet: www.tigard - or.gov Notified/Method:
'04, Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
.r, • ddition/alteration /replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
and 2- family dwelling ❑ Commercial/industrial SFR (2) bath Commercial/industrial
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ) 3 / 3 3 S vii e0C K J Piro -De_ Catch basin or area drain 18.76
City/State/ZIP: 7 /4+��� t2 9 7ZZ3 ootin
F 1, leach line, or trench drain 18.76
g drain (no. linear ft.: ) Page 2
Suite/bldgJapt. no.: I Project name: \ i £ yam,1 Footin 4 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
dAt ii("'"--7--- Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory / 25.02
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan / 12.51
E -mail: • Urinal 25.02
CONTRACTOR Water closet • / 25.02
A c�� y Water heater 37.52
Business name: /�'eLl 70 7440/267//-d; fii/ LLCM Water piping/DWV 56.29
Address: AI/ (/6 7 ' J. 0- Other: 25.02
City/State/ZIP: At , , 0 .. 0 _ t 9t? ‘ Subtotal
Phone: (34,D) 9!'f/ -'CJ5 j Fax: (3 P9 6 -14�jJ Minimum permit fee: $72.50 5 .70
Plan review (25% of permit fee)
CCB Lic.: ' 7t f Plumbing Lic. no.: 7,60 Q State surcharge (12% of permit fee) k "
Authorized signature: TOTAL ■ PERMIT FEE 1 �'��
Print name: Ai LG�4/ JCL 4¢-0,791
Date: , ....42 Ibis permit application expires if a permit is not obtained within 1 0 d ays
after it has been accepted as complete.
"'Fee methodology set by Tn-County Building Industry Service Board.
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