Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00154
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012
Parcel: 2S112BC04300
Jurisdiction: Tigard
Site address: 8360 SW MURDOCK ST
Project: Carleton Subdivision: HAMBACH PARK Lot: 27
Project Description: (1) sink, (1) laundry garage
• Contractor: BRUNER PLUMBING Owner: CARLETON, JOLIN
PO BOX 23985 8360 SW MURDOCK ST
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 -484 -5105 PHONE:
FAX: 503 - 624 -2173
FEES
Quantity Description Date Amount
1 ea Sink 06/05/2012 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 06/05/2012 $12.51
1 12% State Surcharge - 06/05/2012 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 35 ea Minimum Fee Adjustment - 06/05/2012 $34.97
Type of Const: Plumbing
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: ' Permittee Signature: ,4121Ahlif
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 PI
Date/By: ( e ( 'S i2 el f tb "�V /O�`J p W
City of Tigard P
1111111 13125 SW Hall Blvd., Tigard, OR 97223 JUN 0 6 2012 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
i I c `:, 1 Inspection Line: 503.639.4175 CITY OF TIGARD �`e ReadyBy: hii See 2
Internet: www.tigard or.gov ��) Notified/Method: � Supplemental Page Information
. TYPE OF WORK ILDINC - FEE* SCHEDULE- .. .. _. •
❑ New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
EI A ition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION • - SFR (1) bath 312.70
IZt 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi-family SFR (3) bath 500.32
y Each additional bath/lcitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler (- sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION" ‘ Site utilities:
Job site address: 8 ,.. ; Go ' J pj -I, s Catch basin or area drain 18.76
City/ State/ZIP: �9a l' 2 7 2,2____‘.1
ootin
F 1, leach line, or trench drain
!v� Footing drain (no. linear ft.: ) Page age 2
2
Suite/bldg. /apt. no.: I /
Project name: r ea ,� I l Manufactured home utilities 50.03
Cross street/directions to job site: # ,..,_ a Manholes 18.76
d G 13 c � i f- _ k Rain drain connector 18.76
le
j 1 � 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
�y � ��� � / Clothes washer 25.02
/ 'l/ ��� ( �� J , ° Dishwasher 25.02
/AI G� Drinking fountain 25.02
�/ Ejectors/sump 25.02
. ❑ PROPERTY OWNER . : • - • 0 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
1 . ❑ A 'PLICANI'_ .. , ( .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:
/S' in/lavatory GAu4/141 ' 25.02
City/State/ZIP: ar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub /shower /shower pan / 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR " . . • Water heater 37.52
Business name: j3& J,iPy e j.,yy.40l y I Inc,
Water piping/DWV 56.29
Address: Pr Q i cox 23 9 g S' J Other: 25.02
9 p�, City/ State/ZIP: / ,„ 7 ( f (' - 0j7 I -3 / o &S Subtotal
Phone: (55o3) i 24 4 0 Fax: (Sol 6,2_4 - Z)73 Minimum permit fee: $72.50
CCB Lic.: 7( ! 3 7 Plumbing Lic. no.: 2e- V�rs/o,P Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: / -----:- TOTAL PERMIT FEE gl..
Print name: 4 Date: This permit application expires if a permit is not obtained within 180 days
L. L /- day
after it has been accepted as complete. �1
*Fee methodology set by Tri- County Building Industry Service Board.
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