Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00293
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/21/2013
Parcel: 2S114BB02200
Jurisdiction: Tigard
Site address: 16360 SW SYLVAN CT
Project: Mills Subdivision: PICKS LANDING NO.1 Lot: 36
Project Description: Replace 40'of water service.
Contractor: PIPELINE PLUMBING Owner: MILLS,CHRIS
333 S STATE ST SUITE V-108 16360 SW SYLVAN CT
LAKE OSWEGO, OR 97034 TIGARD,OR 97224
PHONE: 503-624-1906
PHONE: 971-246-0322
FAX: 503-624-1926
FEES
Quantity Description Date Amount
40 If Water Service 08/21/2013 $62.54
Specifics: 1 12%State Surcharge- 08/21/2013 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 08/21/2013 $9.96
Type of Use: SF Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature: ON. /� Cl-j7e _ /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
Aug 20 13 02:33p Adam Faren 5036241890 p.2
RECEIVED
Plumbing,Permit Application AUG 2 0 2013
Building Fixtures FOR OFFICE USE ONL\
City of Tigard CITY OFTIGARD aeceiBed (62/ /3 4 I.. - Permit NoP�y2p/3 65 593
1�� DatelBy:
11 13125 SW Hall Blvd.,Tigard,OR 9 1$:ArDING DIVISION Plan Review Other Perron No.:
Phone: 503.718.2439 Fax 503.5';. DateBy:
Inspection Line: 503.639.4175 Date Ready/By: 1�np See meatal Page 2 for
Inf a
r t CARD Internet: www.tigard-or.gov NotiIied/Method: Sakormtion
TYPE OF WORK -, FEE* SCHEDULE
Demolition For special information use checklist I
❑New construction Description I Qty. i Ea Total
dditionfuileration/replacement ❑Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
• CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
SFR(2)bath 1 437.78
and 2-family dwelling ❑Commercial/industrial SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bat /kitchen 25.02
❑Master builder ❑Other Fire sprinkler(__sq.ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: 4 (27 ( j S q 1)a, ) cc,`:i` Drywell,leach Zinc,or trend)drain 18.76
City/State/Z(13:-.1-%(1 a_14( Ci C to 2,
J Cj 7 2. 1 Footing drain(no.linear ft.:� Page 2
Suiteibldg./apt.no.: I Project nnraame: Manufactured home utilities _, 1 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear IL:____) Page 2
- Storm sewer(no.linear ft.:_.) _ Page 2 1
Water service(no.linear ft.:At.) 1 Page 2 C4:2. S9
Subdivision: Lot no.: Fixture or item: I
Backflow preventer 31.27
Tar map/parcel no.: 12.51
Backwater valve
DESCRIPTION OF WORK Clothes washer 25.02
X12 y\';;t( virx) �.i\A'T?X. 5 ViN't 0, • . Dishwasher 25.02
1 Drinking fountain 25.02
Ejectors/sump 25.02
•
ROPERTY OWNER I ❑ TENANT Expansion tank 12.51
ttn^ `y Fixture/sewer cap 25.02
Name: r �`� l Y 11 1l�
q r Floor drain/floor sink/hub 25.02
Address: L 3 CoC`. ` '� �7s `\iai) C CV i* Garbage disposal 25.02
City/StateI21P:< < (kY 4 0 fL Q -1"7 Zy Hose bib 25.02
Phone:F311 ) '2L - 63'2.2_ Fax:( ) Ice maker 12.51
pi �'-CONTACT PERSON Interceptor/grease trap 25.02
Business nam/e: pl C?`\ Medical gas(value:$ ) Page 2
4' Q . / Primer 12.51 L
Contact name: 1 r^' .0 r
J�(��[A �lv� .r {Yl Roof drain(commercial) 12.51
Address: S V.. �.
•_7J 7 � S'r t��'LJ S-fi '�' ,G Sink/basin/lavatory 25.02
City/State/ZIP: �.[it ` C5` j`C, `P �� 'j Li Solar units(potable water) 62.54
Phone:(`�{;J) v�"t . i;Cl(\) la Far: :5:,j)(c;-2 UI . 10.2 Q, • Tub!shower/shower pan 12.51
pelt Urinal 25.02
> mail:7i 7 n
�- pe 1't ne r Cep-i-1 TI&I .�G �`1 i i h Q-/ i.1/1 I
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: D i )Q `i,�Z 1 ey� ko i 1�c' Water piping/DWV 56.29
Address: .� i \ �j i a. j1 S-- lit V.- I C� Other. 25.02
City/State/ZIP: I . (.5. r� ^ Subtotal L.92 1•?
C\\c 2 �,�112.0 :i2 L-1'��'_S�-I - ` D
one:(SL J) (•ZLA `c t C Lo . Fax:GC J)�2 i 7.t.2 I Minimum permit fee: $72.50 .
Cl Plan review (25%of permit fee)
CB Lie.: 17?)`'' C Plumbing Lic.no.: �7�Q P�
�� State surcharge(12%of permit fee)
Authorized signature: 1 \AC'f. Y 4 1n pii J� ). TOTAL PERMIT FEE f j, d
l _ '7 This permit application expires if a permit is not obtained within ISO day
Print Warn :c � �(�tt'°�j"� �'I�,�(�r'��, 1 , Bate: -L� after it has been accepted as complete.
*Fee methodology set by Tri-County Building industry Service Board.
I.1Building`Pcrmitslr.L.MiI•PermitApp doe 10(0tti 44046 HMI 0'0'JOON WEB)