Permit CITY OF TIGARD PLUMBING PERMIT
1 , -- COMMUNITY DEVELOPMENT Permit #: PLM2012 -00216
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/31/2012
IIGAFLD, g Parcel: 2S114BB04800
Jurisdiction: Tigard
Site address: 10080 SW PICKS CT
Project: Vandervoort Subdivision: PICK'S LANDING NO.1 Lot: 25
Project Description: Remove existing downspouts on addition, re -route gutters and add new downspouts.
Contractor: OWNER Owner: MARCHANT, DEBORAH DEWIT
PO BOX 152
WHEELER, OR 97147
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Rain Drain Connector 07/31/2012 $37.52
Specifics: 1 Plan Review 07/31/2012 $18.13
1 12% State Surcharge - 07/31 /2012 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 35 ea Minimum Fee Adjustment - 07/31/2012 $34.98
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $99.33
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:
O d - ff"Pj°Li CffTO
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.
07/30/2012 10:57 FAX a002
Plumbing Permit Application
Site Utilities rOR( Oil WI l S 0\1.1
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City of Tigard 1\ � . �. DR 7 / g f // Permit N'''' /°vy.201 'Oa /4
13125 SW Hall Blvd, Tigard, OR 97223 /
Phone: 503.718.2439 Fax: 503.598.1960 Review Datellay: Other Permit No.:
`; `, , Inspection Line: 503.639.4175 "•""- -" JUL 3 0 2012 Hato Ready/13y: ®see Page 2 for
Internet: www.tigard- ar.gov Notified/Method: ( ' Suppkmmgllnformation
TYPE OF WORK CI TYOFTIGARD • SCHEDULE
❑ New construction ❑ BahlgiNG DIVISION For spider Information use diecki
lacement
Description Qty. I En. Total
Addition/ io
�hOO/mP ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
xi- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02
❑ Master builder ❑ other
Fire sprinkler (___ sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch
Job site address: t 00 co 4j / KC ..5 L,vV fr basin or area drain 18.76 '
City/StateJZIP: 1 c, q � 0 � / ZZG� Do ting leach line, or trench drain 18.76
J Footing drain (no. linear IL : Page 2
Suite/bldg /apt. no.: I Project name: 4 v Q,l1 ,•y tee vl` !t2 uf r Manufactured home utilities 50.03
Cross street/directions to job site: 5e, et v1/4)1 N IRaS C.4- Manholes 18.76
Rain drain connector Z 18.76 31,c 2.„
Sanitary sewer (no. linear R: _) Page 2
Storm sewer (no. linear ft: ) Page 2
Water service (no. linear ft:. Page 2
Subdivision: fr a d I Lot no.: 2-5 Fixture or item: -
Tax map/parcel no.:'2 5 (t T s ts - �s D i0 Backtlow paerenter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
rc w-o r t S +w ) prow, S 1 9 O.r t5 p,,, Qazt t A er to Dishwasher 25.02
re-re v-T �es ( A.� d MR�J u w��S �o„ S Drinking fountain . 25.02 -
Ejectors/sump • 25.02
E PROPERTY OWNER I ❑ imam r Expansion tank . 12.51
C�tILL %(AN fx le_ vo O i�T
Fixture/sewer cap 25.02
Name:
. Floor drain/Ooor sink/hub 25.02
Address: P I3 -X D (SZ- Garbage disposal 25.02
City/State/ZIP: Wk-e. (,Q tr- O .__ en- t ti Hose bib 25.02
Phone: 66) 1-3 - 4-- 554-5 Fax: ( ) Ice maker 12.51
A APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: S ) Page 2
Contact name: , 4Z &g 6 f E. 12.51
�/
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City / State /ZIP: Solar 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: Ow / J 6 R wafer piping/Dwv 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 3 -a ,5 Z.
Minimum fee: $72.50 d
Phone: ( ) Fax: ( ) permit 1-z .5
-
CCB Lic.: Plumbing Lic. no.: - Mi
Plan review (25% of permit fee) t g . 1
Authorized signature: State surcharge (12% of permit fee) 8 .10
gnature: « J TOTAL PERMIT FEE 9 9.3 3
Print name: (Aq Niko Qe vb o Date: I- 301(-1_. Mb permit appliaden expires U • permit is not obtained within 180 days
after It has been accepted as complete.
*Fee methodology set by Tri.CountyBuilding Industry Service Board.
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07/30/2012 10:57 FAX Q001
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