Permit q CITY OF TIGARD PLUMBING PERMIT
111/1 $ • • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00075
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/06/2013
Parcel: 1 S134DB01200
Jurisdiction: Tigard
Site address: 11015 SW 114TH PL
Project: Thrasher Subdivision: WINTERS ADDITION Lot: 6
Project Description: Repipe entire house.
Contractor: DAVIS PLUMBING Owner: THRASHER, HAROLD DEE AND
16008 SE SOUTHVIEW AVE KOVAC, LISA THRASHER
MILWAUKIE, OR 97267 11015 SW 114TH PL
TIGARD, OR 97223
PHONE: 503 - 307 -1920 PHONE:
FAX: 503 - 549 -8970
FEES
Quantity Description Date Amount
1 ea Water Piping /DWV 03/06/2013 $56.29
Specifics: 1 12% State Surcharge - 03/06/2013 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment - 03/06/2013 $16.21
Class of Work: ALT Plumbing
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
issu. • = , • ' • . • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
• ility Notification Cen - Tho e 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 OUN■• callin: •3.232.1987 or 1.800.332.2344.
Issued By: ( � / Permittee Signature: VN
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 Application
Building Fixtures FOR OFFICE. I SE ONLY
City of Tigard tut /By: � 3 / Permit No.: 'a /, l3 ,067
g. D
n 13125 SW I tall Blvd., Tigard, OR 97223
III Plan Review Other Permit No.
Phone: 503.718.2439 Fax: 503 598.1960 Date/By:
T 1 G A R f) Inspection Line: 503.639.4175 Date Ready /By 'oils ® See Page 2 for
Internet: www.tigard or.gov NotifedtMetltod: Supplemental Information
TYPE OF WORK FEE SCHEDULE
❑ New construction ❑ Demolition For. special information use checklist
Description 1 Qty, 1 Ea. [ Total
j g Addition /alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312 -70
' SFR (2) bath 437.78
I- and 2- family dwelling ❑ Commercial /industrial
-
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2 I
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
� -7 pi, Drywell, leach line, of trench drain 18.76
City /Stale/ZIP: GrI -T2-� (} L 7 d
�,. 3 Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt.no.: Project name: ' iv 4 eiy-' Manufactured home utilities 50.03
Cross street/directions to job site: Manhole 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.: _) Page 2
Subdivision: _ Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
'q j ilex, Clothes washer 25.02
M°r 0 (Ci eJ ✓SL U t "✓ i P e
t4.1 - Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER . ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: 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: Davis Plumbing Medical gas (value: S ) Page 2
Primer 12.51
Contact name: Ross Davis
Roof drain (commercial) 12.51
Address: 16008 Soulhview Sink/basin/lavatory 25.02
City/State/ZIP: Milwaukee OR 97267 Solar units (potable water) 62.54
Phone: (503) 3071920 Fax: : (503) 5498970 Tub /shower /shower pan 12.51
Urinal 25.02
E -mail: rdavisplumbing@gmaii.com
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Davis Plumbing Water piping/DWV 56.29 F („
Address: 16008 Southview Other: 25.02
City/State/ZIP: Milwaukee OR 97267 Subtotal
Phone: (503) 3071920 Fax: (503) 5498970 Minimum permit fee: $72.50 7Rt.00
Plan review (25% of permit fee)
CCB Lie.: 163590 - - Plumbing Lic. no.: 3558pb
State surcharge (12% of permit fee) - C, 7 cJ
Authorized signat ` fr -� TOTAL PERMIT FEE L _ a�
I Print name: a 1 i.,t ( t) - 3 . / 3 This permit application expires if a permit is not obtained within itO days h
} t ft' ( _ after it has been accepted as complete. 1 1 � 1 1
*Fee methodology set by Tri- County Building Industry Service Board.
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