Permit IZ-tcY
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CITY OF TIGARD PLUMBING PERMIT
° • COMMUNITY DEVELOPMENT Permit #: PLM2009 -00053
T I GARD 13125 SW Hall Blvd , Tigard OR 97223 503.639.4171 Date Issued: 03/11/2009
Parcel: 2S102BCO3400
Jurisdiction: Tigard
Site address: 13010 SW WATKINS AVE
Subdivision: Lot: 0
Project: Groat
Project Description: Replace (1) w /c, (1) lay, and (1) tub /shower. 5/18/09 ADDED (1) w /c, (1) lay, (1) shower.
Owner: FEES
GROAT, RANDALL S & CAROLYN J Quantity Description Date Amount
13010 SW WATKINS 1 ea Lavatories 03/11/2009 $16.60
TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 03/11/2009 $16.60
PHONE: 1 ea Water Closet 03/11/2009 $16.60
1 12% State Surcharge - 03/11/2009 $8.70
Contractor: Plumbing
LEGACY PLUMBING 23 ea Minimum Fee Adjustment 03/11/2009 $22.70
8985 SW HAZELVERN WAY - Plumbing
PORTLAND, OR 97223 1 ea Lavatories 05/18/2009 $16.60
PHONE: 503-816-8887 1 ea Tub /Shower /Shower Pan 05/18/2009 $16.60
FAX: 503-297-4587 1 ea Water Closet 05/18/2009 $16.60
6 da 12% State Surcharge - 05/18/2009 $5.98
Plumbing (manual)
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $136.98
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 -0100. You may obtain a copy of the rules
r 1
j n Permittee Signature: - •
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
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.
a CITY OF TIGARD PLUMBING PERMIT
s . COMMUNITY DEVELOPMENT Permit #: PLM2009 -00053
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/11/2009
Parcel: 2S102BCO3400
Jurisdiction: Tigard
Site address: 13010 SW WATKINS AVE
Subdivision: Lot: 0
Project: Groat
Project Description: Replace (1) w /c, (1) lay, and (1) tub /shower.
Owner: FEES
GROAT, RANDALL S & CAROLYN J Quantity Description Date Amount
13010 SW WATKINS 1 ea Lavatories 03/11/2009 $16.60
TIGARD, OR 97223
PHONE: 1 ea Tub /Shower /Shower Pan 03/11/2009 $16.60
1 ea Water Closet 03/11/2009 $16.60
1 12% State Surcharge - 03/11/2009 $8.70
Contractor:
Plumbing
LEGACY PLUMBING 23 ea Minimum Fee Adjustment - 03/11/2009 $22.70
8985 SW HAZELVERN WAY Plumbing
PORTLAND, OR 97223
PHONE: 503 - 816 -8887
FAX: 503 - 297 -4587
Type of Use: SF
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 b the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You ma a copy of the ru
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:
Q Permittee Signature: e .1.4.05tj
���J
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
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.
Plwinbing Permit ,Application �? -��� r- 1. ��11 f
Building Fixtures _ FOR OFb Wl l.:SF ONLY
C i t y of Tigard MAR 1 120 A „.r, . 3 • t 0 q , - Permit No. a YY J9 , 0CCFa3
q 1 3 125 SW Hall Blvd.. Tigard. OR 97223 �• , ti .,
_ I ' v Man Review Other Permit No.:
Phone 503.639.4171 Fax 503.598.1960 �� �•' I t � El116s .
– inspection Line 503 639 4175 LI:✓. P }1 \JC DIVI', r ► Ready/By: B See Pege2far
T 11., • P '' Intoner www.tigard or,gov Notified/Method: Effil Supplemental Inferreatlan
TYPE OP WORlc , . FEE* SCHED.111 - , , .r:,, ` „ -
❑ New construction ❑ Demolition For -Win , on use che> ktist
– Dcscri on IMIII Ea. Total _
Addition /alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for cad, utility connection)
•• -•:1•:-.1-11.2t- _ ;�••'” : CATEGORY, OF CoNSI'RVCfON- :.. ` - . - SFR (1) bath 249.20
V
l- and 2- lhmily dwelling El Commercial/industrial 5FR (2) bath
350 00
Accessory building ❑ Multi-family
SFR (3) bath 399.00
—
Each additional bath/kitchen 45.00
❑ Master
builder ❑ Other Fire sprinkler (. sq, ft.) Page 2
'ME INFORMATION -. :. , - JOB '
AND LOCATION. • ". "l" ` Site utilities
lob site address; 1 G / 0 $ j i lik/Aj S Catch basin or area drain 16.60
City /State/ZIP: r yC4... Drywell. leach Imc, or trench drain 16.60
Suite/bldg./apt. no.: l Project name;
Footing drain (no. linear ft.: 2
•�� f- Manufactured oles home utilities 110 00
Cross street/directions to job site: ' [ T L
a Manholes 16.60
1 04.795 t 5 Rain drain connector 16.60
Sanitary 4ever (no. linear ft.: Page 2
Storm sewer (no. linear ft.; ^) Page 2
Subdivi9ion: Lot no. Water service (no. linear it: Page 2 –
Fixture or item
Tax map /parcel no.:
Absorption valve 1 6.60 • • - .. DESCRIPTION O _ WORIk ' " " . • . Backilow preventer Page 2
f (- ( / Rej f 6 Backwatcrvalve 16,60 �� J i ' v" ��11 Clothes washer 16.
Dishwasher 16
ORopE u .. ,• : . . Q •TRNA1 . Drinking fountain 16,60
l j 16 60
Name: 0 4 1' Expansion tank 16 60
Addr�e: / � � � � 4k..1 ( 4,,ift e , ?t) 5 FixturtJsewer cap 16.60
City /State/ZIP: `I" c ..) Floor drain /floor sink/hub 16.60
Phone: ( )
Fax: ( ) Garbage disposal 16.60
. - y 16
APPLICANT " .• . CON`)C'ACT PERSON i. - - 1"Tos bib
Ice maker 16.60
Business n o : •a Znj'q // C.. /v$Y/` ,y1 In[erceptor /grease trap 16.60
v K
Contact name. ! / ° `.` Medical gas (value: $ ) Page 2 —
Address: r9 c fr S1 ∎) 4 ' 6 LOLV 6t o ci Primer 16.60
City /State/ZIP: Tor. yci e I 1 f .
,e 0/ V 5,;),. I s, Roof drain (cnthmercial) 16.60
` / 1 Sink/basin/lavatory 16.60
Phone: ( ) ?„..?/.... ` ? 7 f Fax:: ( ) G d� a 0 Tub/shower/shower pan 16.60
E -mail: /! Urinal 16.60
= CONTRACCOR • , Water closet - i 16.60
Business name: i , � v, " ( 61, Water heater 16.60
Address: Q S r ry T? f.L/EAJ Other:
City /StateIZ � "' �� _^ ��pp Subtotal
tP:
r�L7 LAN...) t-�'C/ Minimum permit fee: $72,50 0
Phone; ( 95 , ry■?■ . Fax: ( ) Residential hackflow minimum permit foe: $36.25 ' s •
Plan review (25% of permit fcc)
CCB Lie.: S � - I Plumbing Lic. no ": 2 (o -5) Q� State surcharge (12% of permit ke) • 1 a
Authorized signatur 0
.t TOTAL PERMIT PEP, ,Z
Print name: MAIr N 06 rd Dote: 5– / 0 Og flit permit application ezpirea if a permit it not obtained within
180 days after it has bete accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
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