Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00009
T 1 G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/08/2013
Parcel: 1 S134CB11500
Jurisdiction: Tigard
Site address: 12241 SW MILLVIEW CT
Project: Subdivision: MILL VIEW Lot: 15
Project Description: Replace 50' of water service
Contractor: BRUNER PLUMBING Owner: BEAN, STEVEN JAY & TERESA LYNN
PO BOX 23985 12241 SW MILLVIEW
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 484 -5105 PHONE:
FAX: 503 - 624 -2173
FEES
Quantity Description Date Amount
50 If Water Service 01/08/2013 $62.54
Specifics: 1 12% State Surcharge - 01/08/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 01/08/2013 $9.96
Plumbing
Class of Work: OTR
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: 4 Permittee Signature:
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 ApplicaticRECEI� / EV n
Site Utilities Y FOR OFFICE USE ONLY
City of Tigard JAN 0 8 2013 Received Permit No .
-
a 13125 SW Hall Blvd., Tigard, OR 97 3,, OF Date/13y: // �/,[3 �� Permit No.: 0�9
g�� l!f Pl Revie � /
Phone: 503.718.2439 Fax: 503.5 TIGARD Other Permit
Date/By:
Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/13y: lu s: Pa 2
TIGARD and - or. ov B
g g Notified/Method: ��� Supp l emental e Information for
Internet: www.ti
TYPE OF WORK FEE* SCHEDULE
El New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Q Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
Z I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building Multi-family
SFR (3) bath 500.32
❑ Multi -famil
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ( 2..2_q( s(,,) vii , ( ( CC" C.,-"T- Catch basin or area drain 18.76
City/State /ZIP: - - 4 0 1 .7 2- 2 F owing d ea ch line, lior near trench drain 18.76 Page
�� � t Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 3 F.c,,` Manufactured home utilities 50.03
Cross street/directions to job site: r J Manholes 18.76
J V � � e.,--- � Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: so Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
POL (� r 1 �, it �, '�^ , Clothes washer 25.02
V W v .� _ Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
ROPERTY OWNER I ❑TENANT Expansion tank 12.51
Name: (� I
/)g72 /`/ _ / Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Contact name: Primer 12.51
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
/ / Water heater 37.52
Business name: n_, e..-1.- �f (J +� /� J ` It( Water piping/DWV 56.29
Address: 2 o G,, Z T 8s Other: Other: 25.02
City/State /ZIP: C 0 2 Subtotal
Phone: ( 5 3 ) 2_4 C/L �� p Fax: ( 5 ) 62_ c- / - Z ("] Minimum permit fee: $72.50 7z / X17
.S.--1-9/2 Plan review (25% of permit fee)
CCB Lic.: R.---( ( t7 3 7 Plumbing Lic. no.: Z� - SLS �State surcharge (12% of permit fee)
Authorized signature: ;.-- - TOTAL PERMIT FEE ,/, e 20
Print name: /�/ ( , - v Date: / /2_____ This permit application expires if a permit is not obtained within 180 days
6 G r / 6� after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Permits\PLMU- PennitApp.doc 10/01/09 440 -4616T(10 /02/COM/WEB)