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Permit
�,�� CITY OF TI GARD PLUMBING PERMIT 1111 a COMMUNITY DEVELOPMENT Permit#: PLM2013 -00156 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21 /2013 Parcel: 2S103CA00106 Jurisdiction: Tigard Site address: 13475 SW 115TH AVE Project: Morgenthaler Subdivision: 2008 -056 PARTITION PLAT Lot: 3 Project Description: Kitchen remodel, install (1) dishwasher, (1) garbage disposal & (2) sinks. Contractor: OWNER Owner: MORGENTHALER, CASS MORGENTHALER, JENNA 13475 SW 115TH AVE TIGARD, OR 97223 PHONE: PHONE: 503 - 209 -2630 FAX: FEES Quantity Description Date Amount 1 ea Dishwasher 05/21/2013 $25.02 Specifics: 1 ea Garbage Disposal 05/21/2013 $25.02 2 ea Sink 05/21/2013 $50.04 Type of Use: SF 1 12% State Surcharge - 05/21/2013 $12.01 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $112.09 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 c [ling 503.232.1987 or 1.800.332.2344. 155 d By: Per Si nature: , ?/ _,....._ i' e(k 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. 5(al //3 6 Ar`la6,15- 60t'5- x,00 ,„ R � Plumbing Permit Application 3 z < RS �ii County Phone: 503- 846 -3470, Fax: 503- 846 -3993, Inspection Request: 503- 846 -3699 Vre ^f95 d.'� A'N Su 350 -12, Hillsboro, OR 7124 www.co.washington.or.us 0R cf� ri t�g Approval: \ Pro # Permit # BUILDING DIV'I:T ©fpF WORK FEE* SCHEDULE El New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total Addition /alteration/replacement 0 Other: New 1- 2 family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 362.50 It I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 465.50 ❑ Accessory building ❑ Multi- family SFR (3) bath 566.50 ❑ Master builder ❑ Other: Each additional bath/kitchen 100.00 Fire sprinkler (# sq. ft.) By Sq. fl. JOB SITE INFORMATION AND LOCATION Site utilities Job site address: / 3 4t 7..c IN II g"t A d e, - Catch basin or area drain 16.50 City/State /ZIP: rr, ,e yii G .r- 4 ` Z r•.-7 Drywell, leach line, or trench drain 16.50 Suite/bldg. /apt. no.: / ! Project name: /j � y . mot l ( Footing Drain (each 100'increment) 48.50 Cross street/directions to job site: 7 Manufactured home utilities 110.25 J p A r� Manholes 16.50 Rain drain connector 16.50 Sanitary sewer (each 100 ft.): # of ft. 48.50 Subdivision: Lot no.: Septic Connection 34.00 Tax map /parcel no.: Storm sewer (each 100 ft.): # of ft. 48.50 DESCRIPTION OF WORK Water service (each 100 ft.): # of ft. 48.00 Fixture or item Absorption Valve 16.50 Backflow preventor 16.50 Backwater valve 16.50 Clothes washer 16.50 a PROPERTY OWNER ❑ TENANT Dishwasher 16.50 I Drinking fountain 16.50 Name: (p SS /f0r n 1,• y tit/ C f Ejectors /sump 16.50 Address: / 3 y 7 S S 7o It g'r - A £Q V e. Expansion tank 16.50 City /State /ZIP: "7-1 9 ro y d G , / 7 Z . • Fixture /sewer cap 16.50 Phone: (S o?� u g 24;730 Fax: (5,43) - 7 6 G �' yep Floor drain/floor sink/hub 16.50 ❑ APPLICANT ❑ CONTACT PERSON / Garbage disposal 1 16.50 Hose bib 16.50 Business name: fil 4 Hydroponic piping system 16.50 Contact name: Ice maker 16.50 Address: Interceptor /grease trap 16.50 City/State/ZIP: Medical gas (value: $ ) By Value Phone: ( ) I Fax: : ( ) Primer (s) 16.50 Residential Re -pipe: 3600 sq.ft/less 105.00 E -mail: Residential Re -pipe: 3601 sq.ft/more 158.00 CONTRACTOR Roof drain (Commercial) 16.50 Business name: Iv / A Sink/basin/lavatory 2- 16.50 , 3 3. 00 Address: Tub /shower /shower pan 16.50 City/State /ZIP: Urinal 16.50 Water closet 16.50 Phone: ( ) Fax:( ) Water heater 16.50 CCB lie.: Lic. no.: Other: Authorized signature: /' �� Subtotal �'/ Minimum permit fee $1-05:09- /C0. Print name: //A, �‘ "41 ,g eN Ln I ,- Date: - 20 Is Plan review (65% of permit fee) $ Zr . This permit application expires if a p rmrit is not obtained within 180 days after it has been State surcharge (12% of permit fee) $ 42.o/ accepted as complete. • Fee methodology set by Tri -County Building Industry Service TOTAL PERMIT FEE $ / /A, 07 Board. S:\FORMS\July 2012 forms/Plumbing Permit Form rev 06- 12.doc