Permit II p CITY OF TIGARD PLUMBING PERMIT
2 - COMMUNITY DEVELOPMENT Permitter PLM2012 -00368
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/26/2012
Parcel: 2S112CA03400
Jurisdiction: Tigard
Site address: 15270 SW 79TH AVE
Project: Trevor Subdivision: DURHAM ACRES Lot: 30
Project Description: (1) shower pan, (1) water heater and (2) water piping DWV - Replace galvanized /cast iron plumbing with
PEX /ABS,
Contractor: OWNER Owner: BRETT TREVOR
15270 SW 79TH AVE
TIGARD, OR 97224
PHONE:
PHONE: 541 - 350 -0383
FAX:
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 12/26/2012 $12.51
Specifics: 2 ea Water Piping /DWV 12/26/2012 $112.58
1 ea Water Heater 12/26/2012 $37.52
Type of Use: SF 1 12% State Surcharge - 12/26/2012 $19.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $182.12
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: C l KS(± Permittee Signature: nn,0 P / c F+ - o a .4/LIVel-f l'
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 Appli cation
Building Fixtures RECEIVED OR OFFICE USE ONLY
City of Tigard ` C1`ed q 1 S Permit N D - • • 13125 SW Hall Blvd., Tigard: OR 97223 DEC 1 8 2012 = eyw i� 1 -` . 24) -00369 Phone: 503.718.2439 Fax: 503.598.1960 Oth r Permit No.:
Inspection Line: 503.639.4115 - Date Ready/By: - 1 :
T I G A R D CITY OFTIGARD e_ Iii See Page 2 for
i l
Internet: www.tigard- or.gov • Notified/Methisi: Supplemental Information
BUILDIA�6 9AII�9AI ---
TYPE OF WORK 'FEE'' SCHEDULE
New construction ❑ Dem( lit ion For special information use checklist.
Description ., I Qty. I Ea. I Total
9 Addition /alteration /replacement ❑ Othet • New 1- 2- fadsily dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath:. 312.70
3 1- and 2- family dwelling El Comt tercial/indi tstrial SFR (2) bath : 437.78
.3 Accessory building SFR (3) bath' 500.32
❑ Mu ltifamily
Each,additimial bath/kitchen 25.02
❑ Master builder ❑ Other
Fire sprinkler`( sq. I.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:, •
Job site address: 15270 SW 79 Ave. . .
. • Catch basin cs area drain 18.76
. ' -- , Drywell, leaf h line, or trench drain 18.76
City/State/ZIP: Tigard, OR 97224
footing drait : -(no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: Project name: Man ufactur home utili 50.03
• Cross street/directions to job site: 79 and Thurston _______•: _____ I 1anl'boles 18.76
_Rain drain ca pnector • 18.76
Sanitary sew a (no. linear, ft.: Page 2
Storm sewer.(no. linear ft': Page 2 ■
:.-T Water serviei� (no. linear It.: Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: • Backtlow pre venter 31.27
DESCRIPTION OF WORK • Backwater wive 12.51
Clothes washer 25.02
Replace galvanized/cast iron plumbing with PEX/ABS Dishwasher 25.02
•
• thinking fou itain 25.02
• Ejectors/sump 25.02
® PROPERTY OWNER C 1 &N �� T Expansion talk .. 12.51
Name: Brett Trevor _Fixture/sewdI Cap 25.02
i
Floor drain /floor sink/hulf 25.02
Address: 15270 SW 79 Ave. Garbage disposal 25.02 • I City/State/ZIP: Tigard, OR 97224 Hose bib 25.02
. Phone: (541)350 -0383 Fax: ( , ) t a maker 12.51
® APPLICANT ❑ CONTAC f PERSON lnterceptor!gt ease trap. 25.02
lsiness name: - Medical gas I value: $ , ) Page 2
-- Primer t, 12.51
;ontact name: Same as property owner
Roof drain (dommercihl). 12.51
address: ;ink'basin/la'ratory 25.02
'ity/State /ZIP: • Solar units (totable water) 62.54 • Phone: ( ) Fax: • (• .,• ) - . fub/showerl% ver pan . 2 1 12.51 .
..
E -mail: • .. Urinal /: 25.02
' - Water closet ; 25.02
CONTRACTOR -+;
. . ' , Water heater 1 37.52 37.52
Business name:
Water pipingDWV 2 56.29 112.58
Address: Other: 25.02
City/ State/ZIP: Subtotal 150.1
Phone: ( ) Fax ( ) Minimum permit fee: $72.50
`
CCB Lic.: Plumbing Lic: no.: Plan review (25% of permit fee) •-
. State surcharge (12% of permit fee) 18.01
Authorized signatire: `, .01 TOTAL PERMIT FEE 168.11 1
Print i ► J ' t �n��_, I Date. I q .121 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
r Q *Fee methodology set by To -County Building Industry Service Board.
rrevor
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