Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit PLM2013 -00226
Date Issued: 07/02/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S111CB01309
Jurisdiction: Tigard
Site address: 14865 SW 104TH AVE
Project: Akin Subdivision: DEL MONTE SUBDIVISION NO.2 Lot: 18
Project Description: Replace 130' of water service.
Contractor: 3 MOUNTAINS PLUMBING Owner: AKIN, ROBIN E
PO BOX 230051 14865 SW 104TH AVE
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503 - 339 -2646
HONE: 503 - 670 -1342
FAX: 503 - 828 -0515
FEES
Quantity Description Date Amount
130 If Water Service 07/02/2013 $100.06
Specifics: 1 12% State Surcharge - 07/02/2013 $12.01
Plumbing
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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: o- / IL / 0,4 i cr 0 ,J
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.
JUL - 01 -2013 12:00 From: To:5035981960 Page:1'2'
Plumbing Perm Applicat -1�
Building Fixtures �L�gVd�� FOR OFFICE _USE ONLY
City of Tigard JUL. 01 2013 Received P emut No
q 13125 SW Hall Blvd, Tigard, OR 97223 Date/8y �S /.3 P t H 02 0/'3 /�Ma0 e.
_ Phone: 503,639.4171 Fax 503 5ritOF TIGARD Date/Byfew Other Permit No.
Inspection Line: 503,639 175 BUILDINGDNISION Date Read ra ® See P. r 2 fur
TIGARD Internet: www.tigard!or.guv Notified/Method kl2 Supplemental Information
TYPE OF WORK ; FEE* SCHEDULE
❑ New construction ❑ Demolition For special i formation use clreckliSL
Description I Qty. 1 Ea. I Total
ZAdditionlalteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUOTION SFR (I) bath 312,70
26- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SI=R (3) bath 500.32
LI Accessory building El Multi-family
Each additional hath/kitehen 25.02
❑Master builder ❑ Other. Fire sprinkler ( sq. 1i.) Page 2
• JOB SITE INFORMATION AND LOCATION Site utilities'
Job site address: /s1gl6 5 j /04[7x!4. � Catch basin or area drain 18.76
t Drywell, leach line, or trench drain 18.76
C ity/State/Z I P: 7;64 OA 9 7 7.7-Li Footing drain (no, linear fl.: _ ) Page 2
Suite/bldg. /apt. no.: Project name:
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.70
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
- - Storm sewer (no, linear ft.; _) Page 2
Wafer service (no. linear ft.: • + W . Page 2 !o. 041
Subdivision: I Lot no.: Fixture or item: -
Tax map /parcel no.; Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
XI PROPERTY OWNER ❑ 'TENANT Expansion tank 12.51
p„ _ /I: /- - _ Fixture/sewercap 25.02
Name: /k-,�r A c.sr� /`tlC.�s'1
Floor drain/tloor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
('hone: (3215) 331 - 2..4,44, Fax: ( ) Ice maker 12.51
APPLICANT I CONTACT PERSON Interceptor /grease trap 25.02 .
Business name: 3 Monk 1$ Medical gas (value: S ) Page 2
tt Primer 12.51
Contact name: ��. 7 • 2-530
RWfdrain (commercial) I2.51
Address: 12, os- / Sink/basirlilavatory 25.02
City /State /ZIP: (:), q7 213 / Solar units (potable water) 62.54
Phone: ( ) Fax: : (SO • d js, 05/b• Tub /shower /shower pan 12.5 t
• Urinal 25.02
E-mail; '!a - r ,L,: •- -emu ,. -
CONTRACT' R Water closet 25.02
Water healer 37.52
Business name: Water plping/OWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal ZBD r Q4
Phone: ( ) Fax: ( ) Minimum permit fee: 572.50
CCB Lic.: /495/.71 T Plumbing Lic. no.: 91
Plan review (25 %ofpermit fee) 4,2_ Q /
State surcharge (12% of permit fee) '?
Authorized signature: ., TOTAL PERMIT FEE
'rh permit application expire; if a permit is not obtained within ISO Jays
Print, name: ANL/AM ate: ^0/13 pp r P
after It has been accepted as complete.
"Pee methodology set by Tri -County Building Industry Service Board.
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