Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00136
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 25111 CA01400
Jurisdiction: Tigard
Site address: 9645 SW SUMMERFIELD DR
Project: Rethinger Subdivision: SUMMERFIELD NO.7 Lot: 339
Project Description: (1) lavatory, (1) shower pan replace shower fixtures and faucet in master bath
Contractor: VICON MECHANICAL CONTRACTOR INC Owner: RETHINGER, SUE
3651 KASHMIR WAY SE 9645 SW SUMMERFIELD DR
SALEM, OR 97317 TIGARD, OR 97224
784,1-1 PHONE
PHONE: 503 -507 -4408
FAX: 503 -540 -5616
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 12% State Surcharge - 05/23/2012 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 35 ea Minimum Fee Adjustment - 05/23/2012 $34.97
Plumbing
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 503.232.1 ,4 P 7 or 1.800.332.2344. 1.800.332.2344. ,/�,/y�
Issued By: C 1 ' j K.( Permittee Signature: ol( Li . Arl 0&L
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. �"{ l
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.
05/21/2012 20:20 5035405616 VICON MECHANICAL #7651 P.001 /001
Plu bins Perinit Application
Building Fixtures FOR OFFICE p SE, C \LV
City of Tigard Recei D a 3 . ,_ Perrot No.: e10I a... c
13125 Sw Hall Blvd.. Tigard, OR 97223 Plan Review
111 Phone: 503.7182439 Fax: 503.598.1960 Day. Omar Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: twig a Sec Page 2 for
G.�.
T i F: i7 Internet www.tigafd - or.gov Notified/Method: /{ Supplemental information •
.. .. . -? -•. .............sr -.. +. ; , ^x.. . .! ',•7 . : . r1;„ :_; ? :': . ... m .. .. . - - - �4� 7 . --,-=.--, F L it 'La ri2�
:_zr/.:.r:r. T > 'sa �.: ?a °• •'e.:_ =:' •.. �.. - . ,- _,____ . �f'� , �' , . -- �.: -v x. � l._ } :. -� F-.__ _._ .. , ... � _ : . . :.... _.. .. � ___ . +....... . _ _ .. ..- ti : +'LfL '�.r
_
_ Q New oonctsuction ❑ Demolition For spe al information use checklist
Description I Qty. I Ea I Total
Addition /alteration/replaootncnt 0 Other_ New 1.2 family dwellings (includes 100 ft. for each utility connection)
" _ :-te_ ;_ - �• - - .. _ _ :- . ;•:-._ -,; .�. :_ =:_r SFR (I) bath 312.70
. ,^ + .:r x rr \ :) � =Y l _._:S: +�C:��.•�`.S��N .�:� +.
)and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 50032
❑ Accessory building ❑ Multi - family
Each bath/kitchen 25.02
0 Master builder ❑ Other. Fire sprinkler ( sq. ft) Page 2
.A :.r: - ± ti't= _ �...
.� ==a •= •_- _ :".. ` i + - x ! : : - _.`_ . . .r s e � Y. M ] - h.1'rj Site utilities:
�:i -=ya ;..M __ , _. / ; Catch basin or area drain 1876
Job site address: 'y b 4 15 '
Drywall. leach line, or trench drain 18.76
City /StetefZll': . /,,(/ik 1 Dt ' 7 2 2 _ Footing drain (no. linear it: _ 1 Page 2
Suite/bldg./apt no.: !_ ( Project name: 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.: f3ackllow prcventcr I 31.27
_ _ 12.51
• p Clothes washer 25.02
Fe c Dishwasher 25.02
4 .,,,...,id-- 4 ' ^ Drinking fountain 25.02
Ejectors/sump 25.02
r;45�r I�` .- sY* `.`••:rte- , - , �.�B�'' ^ �N �... __ �_ gi1.,�� Expansion tank 1151
N an= , '' r�g,� •,✓o Fixture/sewer cap 25.02
N � Floor drain/floor sinkThub 25.02
Address' Garbage disposal 25.02
City/State/ZIP: Hose bib 25,02
Phone: ( ) Fax: ( ) ice maker 12.51
_L = _::_ : -_-' : f " =: ="° i Interceptor/west trap 75.02
- 7.-.2..k. :s�?,•.•. : :> _...0 , _P- _ , .. -.._. ' %..`tom,'
13uaineti• name: (.;19.y�,�GN.9'v Medical value: $ _ Page 2
�DY n s Primer 12.51
Conlilcl name: dl.. Roof drain ( **al) 12.51
Address: 0 96 Sink/bas avatory g 25.02
City /State/Z1P: 11,14..4.-% / q 7O6 2- Solar units (potable water) III 62.54
Phone: (563 ) 6 5e 6271 1 Fax:: ( ) Tub/show. /shower pan 12.51
E -mail Urinal 25.02
- 4: = j] � 4,_? .. .- s .... ._ _. _ .. �
::• ..�, ;_. Water closet 25.02
._ ._ ...: -- water heater 37.52
Business name: V frza,A r P.:Lttrtt•I�e + 00,1, . Water piping/DWV 5629
Address: 36 S% KAS; r WO,/ Other. 25.02
City/Stare/ZIP: S'C,,,/ e: + - D f . / Subtotal ,2, SV
Minimum permit fee: $72.50
Phone: ( Solt ) _Vq - ?/v/ Fax: ( Solt) ..cv0 - J6 /6
CCB Lie.: /' U 0 1/ / Plumbing Lic. no.: a LOQ Plan review (25° /, of permit foe)
-J State surcharge (12% of permit fee) . . 7! )
Authorized signature! '/ TOTAL PERMIT FEE „).0 V
Print name: / i pit ■ Cy/AA MA) Date: ,s of ' This permit spirtiadon expires if a permit is not obtained within I'D days
• after it ram been accepted as template.
•Fee methodology set by TriCoun y Building Industry Service Board.
I LMU- PnnitApp.doc ta11Ii09 d46.46I6T(IGV07lCOIWw'E61