Permit CITY OF TIGARD PLUMBING PERMIT
:
I. COMMUNITY DEVELOPMENT Permit #: PLM2012 -00153
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012
TIGARD 9 Parcel: 1 S136AD01700
Jurisdiction: Tigard
Site address: 6875 SW PINE ST
Project: Blume Subdivision: VILLA RIDGE Lot: 2
Project Description: Replace kitchen sink, dishwasher and shower drain
Contractor: MODERN PLUMBING Owner: BLUME, JULIE E & HENDRIK A
11120 SW INDUSTRIAL WAY 6875 SW PINE ST
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 691 -6166 PHONE:
FAX: 503 - 691 -6771
FEES
Quantity Description Date Amount
1 ea Dishwasher 06/05/2012 $25.02
Specifics: 1 ea Sink 06/05/2012 $25.02
1 ea Tub /Shower /Shower Pan 06/05/2012 $12.51
Type of Use: SF 1 12% State Surcharge - 06/05/2012 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 06/05/2012 $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 or1.8800.332.2344. DLL �/ /� l/
Issued By: `� �� 0 / / ,{ DLL Permittee Signature: App/ ��'�F - / T l u 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.
Jun. 1, 2012 3:50PM Modern Plumbing No. 5523 P. 1/2 5 G
Plumber Permit Application . Building Fixtures R
City of Tigard J UN 0 1 201 ? day: (2 I 2 ,ST Permit NRtit4 a (._r 7( 3
el 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Ober Permit No.:
a t (J L) Inspection Line: 503.639.4175 CITY OF TIGA t Rea y „,, r J pl Se age for
Internet: www,tigard -or.gov Still nu; nIVl dn $rnhe eIhod: 3 CA Sapptemear Info
l rmation _
TYPE OF WORK PEE SCHEDULE
❑ New construction ❑ Demolition For special information tire checklist
Description 1 Qty. Ea. 1 Total
( Addition/alteration/replaccment ❑ Other: New 1- 2-family dwellings (includes 100 ft, for each u1li connection)
CATEGORY OF CONS ioienON SFR (I) bath 312.70
NI I- 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 aprinider ( sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Site utUities; _
Job site address:
to 9'1 S 5 vW p i N E sr Catch basin or area drain l 18.76
Drywall, leach line, or trench drain 18.76
City/Stale/ZIP: T 1( ) AWN) , D'9 q 7 1)3 • •
Footing drain (no. linear ft.: Page 2
Suite/btdglept.no.: j Project name: -IL t Manufactured home utilities 50.03
Cross street/directions to job site: // Manholes 18.76
{ a,M M (\) DE- (0 SS - 1-k 2 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.: T Fixture or item;
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
AefA a tt~ K 1 }' �e N 61 ink I, tdI Sk IJ6c 5{t,a,,r i Dishwasher 1 25.02 7 5
4 1 tr _S 1tia Lo e r a NO A V1 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: • 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
Contact name:
Primer 12.51
Roof drain (commercial) 12.51
Address: sink/basin/lavatory + 25.02 )S, 0)-
City/State/ZIP: Solar units (potable water) 62,54
Phone: ( ) [Fax:: ( ) Tub/ E• , ower pan) r. _ 1 12,51 1 .S
E-mail: Urinal 25.02
•
CONTRACTOR Water closet 25.02
• Water heater 37.52
Business name: tto n c R N ?Lull fi 1 N (s Water pipingfDWY 56.29
Addr+essil130 SW LtibUSIN /IL 1n1p-4 %L l" Other: 25.02
city/State/Z>p: P lan review (25% of � A. L -r- A Al q`1 O ( -2_ Subtotal 4aSs
Phone: (503 / W l (a ILO (p F : (o3 6 ' 4'1 `l I Minimum permit fee: $72.50 7 )• 7
1 CCB Lie.: a , el Itlmbing Lie. no:3 4 ),c-0 P.�B permit fee) State surcharge (12% of it fee
Authorized signat r& /L k i, / C p� 70 t. TOTAL PERMIT FEE a 1 . D n
(Print name r �� 1 t) , k t I b ats 1 ^ 1 I This permit appllearten expires to permit it not obtained within 180 days /
1 1 after it b as been accepted as complete.
*Fee neethodology set by Di -County Building Industry Service Board,
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