Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00140
T ( c AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 1 S135ACO2500
Jurisdiction: Tigard
Site address: 9346 SW MANDAMUS CT
Project: Longstaff Apartments Subdivision: ASHBROOK FARM Lot: 25
Project Description: Building 4. Plumbing for (6) unit apartment building.
Contractor: WOLCOTT PLUMBING Owner: J.T. SMITH CO
1075 W HISTORIC COLUMBIA RIVER HWY 5285 MEADOWS RD SUITE 171
TROUTDALE, OR 97060 LAKE OSWEGO, OR 97035
PHONE: 503 - 667 -1781 PHONE: 503 - 975 -7639
FAX: 503 - 667 -9891
FEES
Quantity Description Date Amount
100 If Sewer Service 06/27/2012 $62.54
Specifics: 100 If Storm and Rain Drain 06/27/2012 $62.54
100 If Water Service 06/27/2012 $62.54
Type of Use: MF 6 ea Clothes Washer 06/27/2012 $150.12
Class of Work: NEW 6 ea Dishwasher 06/27/2012 $150.12
Type of Const: 1 ea Expansion Tank 06/27/2012 $12.51
Occupancy Grp: 6 ea Garbage Disposal 06/27/2012 $150.12
Stories: 2 2 ea Hose Bib 06/27/2012 $50.04
6 ea Sink 06/27/2012 $150.12
14 ea Lavatories 06/27/2012 $350.28
10 ea Tub /Shower /Shower Pan 06/27/2012 $125.10
10 ea Water Closet 06/27/2012 $250.20
6 ea Water Heater 06/27/2012 $225.12
1 12% State Surcharge - 06/27/2012 $216.16
Plumbing
Total $2,017.51
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 que to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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
City of Tigard
I " 13125 SW Blvd., Tigard, OR 97223
il Hall
Phone: 503.718.2439 Fax: 503.598.1960 Dateffi Receivea r 3 -- av , Pannt No.: elegeva.610/
Plan Review
Date/By: Other Permit No.: e 5 t ag oo _ 000 76,
Inspection Line: 503.639.4175
HGARI) N Dar ot e i :eady/fly: 0, 41 , 7 __ItIris: e See Page 2 for
Internet www.tigard-or.gov : Supplemental Information
. - 1 1 Z I Y -- : - "Z' ' .:1:4'1, , .V - 04,,O,10;01cgi. , 0:';.:" ,: • , .,•,.,; .z= ';'4:. ;, - ,.f - - - :1 .; ', .. F EE. SCIIEDULE
tio New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other New 1- 2-family dwellings (includes 100 ft. for each utility connection)
061*****tti .f....Z:&041;iti4:!t SFR (0 bath 312.70
0 I- and 2-family dwelling 0 Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
0 Accessory building IXI Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other Fire sprinkler (._ sq. It.) . . Page 2
. -- **007 ' A14.$l: ' 1 4 Ig'.:IT : 0: - Cik;44- S ite uftlilies:
Catch basin or area drain 18.76
* Job site address: q3-71„, 736,; .736p, dr3sy ..31.1 m...liel Gt, -
Drywell, leach line, or trench drain 18.76
City/State/ZIP: -r- el a _ r A 1 6i2_ e 1 7, 7- 5 925O 3 y‘::.
Footing drain (no. linear ft.: ____) Page 2
Sui -I • ldg./..t. no.: 4V Project name: 1etiN04S Manufactured home utilities 50.03
Cross street/directions to job site: (, U/11/ r A Lave Manholes 18.76
0-1.4) LA 2. ri ev G r i_e_vit2wri 0 -0 ( -/5 14 ' , L ..‘ Rain drain comtector 18.76
Sanitary sewer (no. linear ft.: LW) I •'. Page 2 4g.
Storm sewer (no. linear ft.: ab r ,./ Page 2 1 6a .5 f<
q 5 q 34ip c L.0 rY■ ift et. ia tr
t Water service (no. linear ft.: till:■) I 1 v / Page 2 (pa .6-
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer - 31.27
• .,.-.4 „...7, ,.. ..„.'..7- . .• - 2. : - - ., . - .., , _ , , : , •:•,;& ; ; ; ,,, :: ..,,;4v.,.,;•,;:*-4' Backwater valve -... 12.51
_. 1;;' .-:i': kegml'4,i=1.42-2aliaitl'O.L; , .* Clothes washer ( k/ 25.02 I gc, . -,
t 4...tte-4act AL-. ••• s . ‘ 4 6 LT Dishwasher ( -, 25.02 I G 12- ,
Drinking fountain 25.02
Ejectors/sump - 25.02
:;:,-ig;itArirtit.-irtgalintgiAtagitWittit*Free-,%.W410,V•2 Expansion tank I • • 12.51 0_61 .."
Furcate/sewer cap -- 25.02
Name: - M:r SleA:vt■i. cert.: t.c%. Floor drain/floor sink/hub - 25.02
Address: . 6243S
VI
... I.. In . ... • . Garbage disposal (0 '/ 25.02 Igo. • •■•-,
City/State/ZIP: 1_,04„Xyz_,,, C) _-- A, 0 • crtoZS Hose bib 2 ./ 25.02 .5 .
Phone: (cal) . 3as - 1.H Fax: (5 6 1 )( a • tr Ice maker 12.51
gfaita? yA Interceptor/grease trap - 25.02
Medical gas (value: S ) ••••• Page 2
Business name: -r le A 4 L A_ c
i Primer --- 12.51
Contact name: C,k.o.A 15 r I. c Roof drain (conunercial) - 12.51
Address: S2.96 Mttu4o a)s eoe,k g(-e_ n I Sink/basin/lavatory C 57 2, C;:e • 25.02 50 V
City/State/ZIP: L kict_ D ,,v . u 012. et 7 C)3 Solar units (potable dr) 62.54
Phone: (51.35) ell 5... 1 ( 1 Fax: : ( 50 ) Lo Si DI D 2 Tub/shower/shower pan 1 D 12.51 12S 1 V
Urinal --• 25.02
E-mail: e .,6 r i az....t..c 6 j i'S nA tik co , c_ 0 et" • #
Water closet i 0 25.02 S: 2C:a
• ;;,."•_;,.•-rcY•T.,• .i-. , ,: 4eg . _,;:g, •
(0 37.52
Business name: . 010 ,, i , . . . _ i 1a,le:1 - A...., ) Water piping,/DWV 56.29
Address: I 616 k • a . % stat--‘c,.... ta ‘4t. , % - 44 .1 ( %ALL Other.
25.02
City/State/ZIP: - ci c) ,.. ) , \ lb 9... • - 411 Subtotal tp•G":2
Phone: (*a )\_V \ X 302_ Fax: (Sol ) ( -cusq. \ Minimum permit fa: 572.50 ' - • , 1 to
Plan review (25% of permit fee) -- 4 ,
CCB Lic.: ‘‘ . . 11111 Plumbing Lic. ito.ia ., _8„,),.
State surcharge (In, of permit fee)
Authorized signature: - A ,_ TOTAL PERMIT FEE I
Print name: - \ -- e_vtg‘ VA. ("0,xaetx=rt Date: - % 2 This permit application expires if a permit is not obtained within days
after it has been accepted u complete.
'Tee methodology set by Tri-County Building Industry Service Board. Ki
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