Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00163
T (GA R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2012
Parcel: 25111 DB10100
Jurisdiction: Tigard
Site address: 15465 SW OAKTREE LN
Project: Jones Subdivision: SUMMERFIELD NO.10 Lot: 589
Project Description: (4) sink, (1) tub, (2) water closet for 2 bathroom remodels and kitchen
Contractor: MODERN PLUMBING Owner: JONES, RICHARD
11120 SW INDUSTRIAL WAY 15465 SW OAKTREE LN
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 691 -6166 PHONE:
FAX: 503 - 691 -6771
FEES
Quantity Description Date Amount
4 ea Sink 06/07/2012 $100.08
Specifics: 1 ea Tub /Shower /Shower Pan 06/07/2012 $12.51
2 ea Water Closet 06/07/2012 $50.04
Type of Use: SF 1 12% State Surcharge - 06/07/2012 $19.52
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $182.15
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.
i 1
Issued By: :- , I/ , Permittee Signature: O ` 1 ( Pp[) I ( i 1 . `i' rt '
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 1 IJI�
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. 6. 2012 8:22AM Modern Plumbing No. 5579 P. 1 $ �
Plumbing Permit A► licatiO CEIVED 2,(1- '
Building Fixtures JUN 06 2012 FOR OFFI('E I.!SE ONLY
City of Tigard Reeeived
wig* (e( - z 11 Z Sr Permit NoPaii( cot 4 3
a 13125 SW Hall Blvd., Tigard, OR 97 Pn Re v
111 MI
OFTIGAItID taaxe
Phone: 503.639.4171 Fax: 503.5' ;
1 I ING DIVISION Dale/BY:
� i i• Inspection Line: 503.639.4175 Date Ready/By:
, i 11(.1P See Page 2 for
Internet www.ligard or.gov Notfied/Method: - I Supplententnl Iatarm.In n
TYPE OF WORK FEE* SCHEDULE •
❑ New construction ❑ Demolition
For special information use checklist.
Addition/alteration/replacement ❑ Other:
Description 2-f ft. Qty. Ea 1- - femlly dwellings (includes 100 for each utility Total
New w co,mectial)
CATEGORY OP CONSTRUCTION SPR (I) bath 312.70
( I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
' ❑ Accessory building El Multi-family SPR(3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (__ sq. ft.) Page 2
JOB. SITE AND LOCATION Site utilities:
Job site address: 1 V-1 b S 5 era ( ) G. k�e L 0,_,,,,,_ Catch basin or area drain 18.76
Drywel!, leach line, or trench drain 18.76
City /State/ZIP: T j 0 VL. 4 l ` 1 ) a I-1
c 1 Footing drain (no. linear ft.: ) Page 2
Suite/bldg /apt. no.: Project name: y me 5 Manufactured home utilities 50.03
Cross strceVditections to job site: Manholes 18.76
The ►4^-4 -S C., u Z <P_ G SS C-1 Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear II.: Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Baddlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25,02
re 'W)lDJ .> b e...'( -t, s 4 ic. , Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
_
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: w 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 Inlereeplor/gnase Trap 25.02
Business name:
Medical gas (value: S ) Page 2
. Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory if 25.02 / Dopg
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) y I Fax :: ( ) Tub/shower /shOWer l 12.51 /).S/
E -mail:
Urinal 25.02
CONTRACTOR Water closet 2. 25.02 SO, DV
• Water healer • 37.52
Business name: m0 h ere-to a LA) !M% 1 N V
Water piping/DWV 56.29
Address: )11)O Stn/ 1N1)UShJAL WA.y RIG 9.3 Omer: 25.02
City /State/ZnPTuALptrlls O IR q"/p t, Subtotal 1 ,lea
Phone: (5-03) b i 1 - / al Fax: ( Slag ben - 71 / Minimum permit fee: $72.50
Plan review (25%of permit fee)
_
C .le.: 5 7 qD t, /umbing Lic. no.3 ti •- Q 1 _ State surcharge (12% of permit I a •
Authorized signature: `J)/2 t ( Pc fee ) S /
k !"t.�c -u0 y 71t. TOTAL PERMIT FEE ) Q ) ,15" ✓
I Print name: N-A 4 K-0-4.) cm-as K-1 I Date: (0 it f /_ Ms permit application expires If a permit Is not obtained within Ilia dpys
after it has been accepted as complete.
*Fee methodology set by Tri- County Build Industry Service Board.
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