Permit R EVISE D
n CITY OF TIGARD 3- /� . PLUMBING PERMIT
' . COMMUNITY DEVELOPMENT Permit #: PLM2013 -00071
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2013
Parcel: 2S112CAl2800
Jurisdiction: Tigard
Site address: 15610 SW 76TH AVE
Project: Wererlin Subdivision: RENAISSANCE WOODS NO.2 Lot: 52
Project Description: (1) Backflow preventer
Contractor: PLUMBING CONCEPTS INC Owner: WETERLIN, JOSH
PO BOX 1068 15610 SW 76TH AVE
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 658 -5232 PHONE:
FAX: 503 - 658 -5232
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/28/2013 $31.27
Specifics: 1 12% State Surcharge - 02/28/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 02/28/2013 $41.23
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: ` / Permittee Signature: 9 4/2/ ,, - 11 ,/
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.
Feb 28 2013 11:11AM PLUMBING CONCEPTS INC 5036585232 p.1
Plumbing Permit AnplicationhECEIVED
Site Utilities FEB 28 2013
City f Ti � Received t 9_, g 13 1
131 S W Hall Blvd., Tigard, OR 972c3iTY OF TIGARD Daly' Permit No. 3 �
Plan Review
�� 11 Phone: 503.718.2439 Fax: 503.5DIRgoDING DIVISION Date/By. Omer Permit No.:
I ; , , t B I ; inspection Line: 503.639.4175 Date Ready/By: . T i c , a See Page 2 for
Internet: www.tigard- or.gov Notified/Method: t 1 ° Su
, �t'a r i µ , I � rt>0 9 n n•., , enamel Information
,
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t - N a dd i t d i� i ire g Ef m l a a u g
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❑ New construction ❑ Demolition For !pedal information use checklist
® Addition /alteration/replacement Ne 1- t-faulon Qty. � Ea. 1 Total
�y �;a ❑ Other New 1- 2 ty dwelling (includes 100 ft for each utility connection) }
;Nx 4 1 . ' 'I•. , tl tr s e r y: Act r , ',„, tt1 .oii.it'�ptsi A SFR (I)bath 312.70
a 1. �m .4e -i l't > s ... 'r .t .
® 1- and 2 -faml ly dwelling ❑ Commercialfindustrial SFR (2) bath 437.78
❑ Accessory building SFR (3) bath 500.32
ry g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other
,. r, II p� 1��rgt�ur �u e,l � tus'�. q {�- ,, l�� ,, k �' lt { Fire sprinkler ( sq. ft.) Page 2
il , I ,l 1 ' i.'t' , P.`t" • '�.r9;PwJNI� i lLlur�U ,l i ?d'.' lc I sI I . GI ° W rl �`Ar¢ jil / ry
a , Mv: Site 'aides:
Job site address: 15610 S.W. 76 Ave I�JT[� Si basin or area drain
_
Drywell, leach line, or trench drain 18.76
CitylStateJZIP: Tigard, Or. 97224 _ Footing drain (no. linear ft.: ) Page 2
Suite/bldgJapt. no.: I Project name: Weterlin Res. + Manuthcntred 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 ll: `j Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item;
Tax map/parcel no.: Backtlow preventer 1 31.27 31.27
- En i K P ' �4 a wrr Alt■ I ::t „• '1, , r • 1•`+ -'r• Back valve 12.51
a k �� VI e..... tl ' ` , 9 4 4 1 i 1 I
3 1'1 1 � 1 >I t • 1 i 1 E L I nn ikon ;i ral:i3 -.. . 5 { r'ti' C, �il: ::, .',� , # 4. J T,119 ; i
Clothes washer 25.02
Install doable check for irrigation. -
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
�. t I 1 I ctt0""s' 7a,c.1 t, i .."&:',.4S, „ a ,� : p tl • ,., ^ . , . , y p
a i i. ; I :1." F ° d .�#� 1 S I k 1 , .r' I I a x ` ', ■ r'" Expansion tank 12 51
1 , +' �� i �ts��ett�t s �ir ?.i!'er �, �I,,.Bral;l�i � _ � , '•.:.,, ,,a+ Ir +�ll'
Name: Josh Weterlin Fixture/sewer cap 25.02
Floor drain/8oar sink/hub 25.02
Address: Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
, r, �: -,. k � vtcpata
rJ { w3 :�•, a q i . ;,--11'S v '''' n lu e a 1:?S' +' l.,'• lntercercearease trap 25.02
]f,.l s IilY.f�cJJils, �n FCi i'� •.' N k �i *'i{ � .:. � . •.an �.j
.5 vii., ..
Business name: Plumbing Concepts, Inc Medical gas (value: $ ) Page 2
Contact name: Jesse Zamudio Primer 12.51
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units (potable water) 62.54
Phone: (503) 317-0864 I Fax: : ( ) Tub/shower/shower pan 12.51
E-mail: plumbingconeepts1 gmaiLcom Urinal 25.02
°drip Fr;•A3fl ��s � ' r• u q+ • ) eRIW t�•^" "i.�y n,r� `Tl¢r k I -
Water closet 25.02
® I r , Void (0 � :11 ; ,11 r :iFs I 1 u �{!!f �'11'�l ;i ��; :� 11 1 did + t; It t 4 1
�. i+ A 5 a �� 19. A'i . . I' _ t -- II L�i ,
7rU51 � �ti��ll- .fi[•iai .,,. ' _ ,i, ,4 ,•. ..�:i�_�.�'� �'�.r'; water heater .
3752
Business name: Plumbing Concepts, Inc.
Water pipirg/DWV 56.29
Address: P.O. Box 1068 Other: 25.02
City/State/ZIP: Clackamas, Or. 97015 Subtotal 31.27
Phone: (503) 658 -6232 Fax: (503) 658 -8553 Minimum permit fee: $72.50 72.50
CCB Lie.: 97587 _ - Plumbing Lic. no.: 3 -293PB Plan review (25% of permit foe)
Authorized si A� - `- State surcharge (12% of permit fee) 8.70
s d - -. . � TOTAL PERMIT FEE 81.20
Print name: Lisa Zamudio Date: 2/28/13 This permit application expires if a permit Is not obtained within 180 days
after it bas been accepted as complete
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Buadirg\PermbstLMU- PemrttApp.doc 10/01109 440-4616T(]0/02ICOM/WFB)