Permit •
CITY OF TIGARD PLUMBING PERMIT
g,_ COMMUNITY DEVELOPMENT Permit #: PLM2012 -00192
T t G AR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2012
Parcel: 1 S 136AD01700
Jurisdiction: Tigard
Site address: 6875 SW PINE ST
Project: Blume Subdivision: VILLA RIDGE Lot: 2
Project Description: Replace 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 Tub /Shower /Shower Pan 07/16/2012 $12.51
Specifics: 1 12% State Surcharge - 07/16/2012 $8.70
Plumbing
Type of Use SF B0 ea Minimum Fee Adjustment - 07/16/2012 $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: AM/hi 'n ' f � Permittee Signature: D o /� pp , p n�
Ca ) 500 , 3.63 3 9. 14175 by 7:00 a.m. for the next available inspection date. 4 1 Y �l 1. I-r
Y P
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.
Jul. 12. 2012 3:18PM Modern Plumbing No. 6118 P. 2
, Plumbing Permit Application
Building Fixtures
R i Received RJR 01.1 lira: ONLY
City of Tigard �(� r Per mit NoJ Ki��
: 74 - V 13125 SW HaII Blvd., Tigard, OR 97223 Daleniy '"� e 7� /o �� / 9
Phone: 503.639.4171 Fax 503.598.19ti� 12 2012 Ph" Review
D trig Other Perron ig OW a_ opi53
Inspection Line: 503.639.4175
I I i; ,\ I; L1 C OF TIGARD N im/ma Ready/By: See Penal for
IInternet: www,ligard -OLgoV NdiGedrMethod: L S upplemenrallafoematlen
TYPE OP WCILDING DIVISION PEE' SCI;IEDULE
❑ New construction ❑ Demolition For spade! Is/'ornin1io,, use checklist.
Description I Qv. I Ea. J Total -
E 'Addition/alteration/replacement ❑ Other: New I- 2- famlly dwellings (includes 100 Q for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
I' I- and 2- family dwelling ❑ ConsmereiaUndustrial SFR (2) bath 437.78
❑ Accessory budding ID Multi•family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler (_ sq. R.) _ Page 2
JOB srrE INFORMATION AND LOCATION Site utilities;
Job site address: 6 & S $ 1),J pi to e Si- Catch basin or area drain 18.76
-O 012- ci 7 )-
3 - Drywell, leach line, or trench drain 18.76
City/Stale/ZIP: T1 (s fr
m Footing drain (no. linear R: ) Page 2
Suite/bldgfapt. no.: l Project name: ,C L m g. Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
'1 / /k s LiU (n E (047S - ft 2- Rain drain connector 18.76
• Sanitary sewer (no. linear R.: ) Page 2
Storm sewer (no. linear R.: ) Page 2
Water service (no. linear R.: ) Page 2
Subdivision: I Lot n0.: Fixlnre or tleni:
Tax map/parcel no.: Bacldlow preventer 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
ela-ct ,- n e' Clothes washer 25,02
re Skow-' _ Dishwasher 25.02
Drinking fountain 25,02
EJeclors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion lank 12.51
N ame: Fixture/sehver cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /Slate/ZIP: ' _ - Hosebib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
[] APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business Home: Medical gas (value: S ^ ) Page 2
Contact name: Primer 12.51
Address: Roof drain (commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax: ; ( ) Tub/shower /shower pan pr I i 12.51 1 , r/
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
�• Water heater 37.52
^
Business name: ! , . OD ‘, it. ? LU Q))Nl (ZI Water piping/DWV 56.29
Address: ( I 11. D SW x US ne_IA.LL limy d /pe q-3 Other. 25.02
City /State/ZIP: I IJ Ai A r //v 04_ q706.1.. Subtotal f ?S/
Phone: (03 . I ( I k (, Fax: 3) 64 I L Z -t i Minimum permit fee: $72.50 7).n)
.7 MD 3 K�s� � 1 Plan review (25% of permit foo)
CCB Lie.: Plumbing Lio. no.: �/�
State surcharge (12% of permit fee) fa 70
Authori2ed sign, ... /�� f a 42 _ � TOTAL PERMIT FEE 104 d ✓
D ate: `7 This peanut appbcalion expire If a perm!! Is not obtained within 150 days
• alter It has been accepted as complete.
'roe methodology ad by Tri- County Building Industry Service Board.
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