Permit CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit #: PLM2012 -00155
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012
Parcel: 1 S133CC01100
•
Jurisdiction: Tigard
Site address: 14032 SW SPRINGBROOK LN
Project: Melvin Subdivision: PEBBLECREEK Lot: 5
Project Description: (1) tub Change Master bathtub
Contractor: BRUNER PLUMBING Owner: MELVIN, PATRICIA
PO BOX 23985 14032 SW SPRINGBROOK LN
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 484 -5105 PHONE:
FAX: 503 - 624 -2173
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 06/05/2012 $12.51
Specifics: 1 12% State Surcharge - 06/05/2012 $8.70
Plumbing
Type of Use: SF 80 ea Minimum Fee Adjustment - 06/05/2012 $59.99
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.
Issued By: , I 4 Permittee Signature: oil 4 o j64
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 Application
Building Fixtures
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City of Tigard r R i permit N . .7 131 SW Ha Blvd., Tigard, OR 972 AI t 6 2012 Plan Review Plate/By: k I �}- Sr `l �lo� '''00 (6 Phone: 503.639.4171 Fax: 503.598:196 Date/By: Other Permit No.:
� � k \ R t Inspection Line: 503.639.4175 / ;�9 Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov CITY OFTIGARD Notified/Method: 114 Supplemental Information
' . : :TYPE of 'AWING OM SK* .. _ - FEE• SCHEAULE: . ' . _ •
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
WAddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY "OF CONSTRUCTION • ' SFR (1) bath 312.70
2i- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ 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: o 3 Z S A) J f) rI ^ O k L f �/ Catch basin or area drain 18.76
City/State/ZIP: 'T a (Z ot 7 i2, Drywell, leach line, or trench drain 18.76
i F oot i ng d ra i n (no. l inear ft.: _) Page 2
Suite/bldg./apt. no.: I Project name: rej v r ;,%, Manufactured home utilities 50.03
Cross street/duections to job site: l it) t a � { e �S Manholes 18.76
(/V W 1 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
. DDESCR.WI ON OF WO RK - Backwater valve 12.51
' ' Clothes washer 25.02
C}11 J7ieLy bQZ � Dishwasher 25.02
O Drinking fountain 25.02
Ejectors/sump 25.02
. ❑ PROP ER1Y -OWNER - _1 ❑ 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
❑ APPLICA1VT" .. _ . , , ❑ .CONTACT PERSON : . Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name: Primer 12.51
Roof drain (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: : : Water closet 25.02
Water heater 37.52
Business name: C3rvne 6, 4 .h , / Let y n L Water piping/DWV 56.29
Address: 2 , Q , 'O)t 23 Q / 'g S' Other: 25.02
City/ State/ZIP: -7;w , (, o? 7 I - 3 / o �S Subtotal
/
Phone: ( c$3) 624:4-812 t Fax: (S &2,.<4.-- Z) 73 Minimum permit fee: $72.50
CCB Lic.: '! 3 7 Plumbing Lic. no.: 2e- vsrSPf� Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: (J ✓I/l
/ _ l )AGt%, J e P7 Date: (�i' //�/2,.. This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:t Building \pennits\PLMU- PemtitApp.doc 10/01/09 440.4616T(l0/02/COM/WEB)