Permit CITY OF TIGARD PLUMBING PERMIT
i • - COMMUNITY DEVELOPMENT Permit #: PLM2012 -00365
T f GARE) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012
Parcel: 2S112BA08700
Jurisdiction: Tigard
Site address: 7820 SW BROOKLINE LN
Project: Tanner Subdivision: BONITA TOWNHOMES Lot: 23
Project Description: (1) Clothes Washer hook -up
Contractor: THE PLUMBERS INC. Owner: TANNER, WILLIAM F JR
90 NW 150TH AVE 8085 SW CHURCHILL CT
BEAVERTON, OR 97006 TIGARD, OR 97224
PHONE: 503 - 781 -1225
HONE: 503 - 519 -6644
FAX: 503 - 684 -1202
FEES
Quantity Description Date Amount
1 ea Clothes Washer 12/18/2012 $25.02
Specifics: 1 12% State Surcharge - 12/18/2012 $8.70
Plumbing
Type of Use: SF 47 ea Minimum Fee Adjustment - 12/18/2012 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /�
Issued By: Permittee Signature: DA 4PPLI (r.7C)J
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
Dec.17.2012 10:40 AM The Plumbers Inc 503 684 1202 PAGE. 1/ 2
Plumbing Permit A>pulicatioR
Building Fixtures DEC 17 2012 ' (,a t it l'( I I ,1 \1
City of Tigard Pcrmit No.: P c iu 0- - 01)30
r 13125 SW Hall Blvd.. Tigard, OR 9 Ty OF TIGARD Plan Review
I Phone: 503.718.2439 Fax: 503$' : r Other permit Na
Ina lion Line; 503,639.4175 • : DI DIVISIO Dato/By:
i I t . \I : I \ ' D✓te Ready/By Juiit:, � so See Page 2 for
Internet: www.tigard- Or,gov Notified/MOthed: 't i 1 '_ Sapptemeatailnformadon
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description _ I city. 1_ P.a. I Total
Addition /alteration/replacement 0 Other. New 1- 2- family dwelling, (includes 10011 for each utility connection)
CATEGORY OF CONSTRUCTION • SFR(1) bath 312.70
1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ID Multi-family SFR (3) bath 500.32
El Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. It) Page 2
JOB SITE INFORMATION AND LOCATION Site udlitie:
Job site address: r C I' 7 _, ,..4,1 Catch basin or area drain 18.76
(� Zb ?W CXIf� Drywall, leach line, or trench drain 18.76
City/State/ZIP; 1 0 rct , D)2- g 7Z2
Footing drain (no. linear ft. ) Page 2
Suite/bldg./apt no.: Project name: Manuflictured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no, linear ft.: ) PA$e 2
Subdivision: � Lot no.: _ Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK backwater valve 12.51
Clothes washer 1 25.02 oz
..t... d - '. for . • % L . ' • b K- l._ • Dishwasher �5
Drinking fountain 25,02
Eje:tors/sump 25.02
'1 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: 1 It T0.nLf Fixture/sewer cap 25.02
D ZD Floor drain/floor sink/hub 25.02
Address: JW 3 ro�kV n I
�(( Garbage disposal 25.02
City/State /ZIP: l tq alai, r dp.- g7Z2.
}lime bib 25.02
Phone; (563) .7 gf �? 12 25 Fax: ( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25,02
Business name: OLD mbilks - 0 . 1 c . Medical gas (value: S ) Page 2
��� il 1' Primer 12.51
Contact name: t \ IiLtLL 4TA ynne
Roof drain (commercial) 12.51
Address: Q O N to ) fi rr VQ-- , Sink/basin/lavatory 25.02 ' • -.
City /State/ZIP : _a(2 avkithor) L d r^ 1 001n Solar units (potable water) 62.54
Phone: (5O3) S` Cl_ (, 1./L/ Fox: ( C� ) /, - , T Zp Tuh/ehower /shower pan 12,51
J -mail: j Urfa-h&j t p� bQRS inc. . f?2-{ Urinal 25.02
CONTRACTOR Water closet 2502
Water heater 37.52
Business name: S tt/7isz a s LLbol Water t to WV
P'P' g/m 56.29
Address: Other.
25.02
City /State/ZIP: _ Subtotal
Phone; ( ) lax: ( ) Minimum permit fee: $72.50 , -) z , co
CCB Lic.: l '� 7 y/ q Plumbing Lic, no.: Pg i. f q 7 Plea review (25% of permit fee)
State surcharge (12 %afpermit foe) $ , ]
Authorized signature: TOTAL PERMIT FEE 6/ t '2-O
Print name; inn.e1; Date: /z - 7 -/ Z_ .�J lki =Pima Permit 'PP on ptrm if a permit le not obtained within 180 days
after it has bean accepted ite complete.
'Fee mothodolOgy sat by 'I'd-County Building Industry Service Board.
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