Permit a CITY OF TIGARD PLUMBING PERMIT
311 2 '- COMMUNITY DEVELOPMENT Permit#: PLM2013-00314
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09!10/2013
Parcel: 1 S134BD11100
Jurisdiction: Tigard
Site address: 10957 SW 118TH CT
Project: Brokke Subdivision: PENN LAWN ESTATES NO.2 Lot: 39
Project Description: Kitchen remodel
Contractor: MODERN PLUMBING Owner: BROKKE, CHRISTIAAN J
11120 SW INDUSTRIAL WAY 10957 SW 118TH CT
TUALATIN, OR 97062 TIGARD, OR 97223
•
PHONE: 503-691-6166 PHONE:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
1 ea Dishwasher 09/10/2013 $25.02
Specifics: 1 ea Ice Maker 09/10/2013 $12.51
1 ea Sink 09/10/2013 $25.02
Type of Use: SF 1 12%State Surcharge- 09/10/2013 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment- 09/10/2013 $9.95
Occupancy Grp: Plumbing
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 B . 4 � W Permittee Signature:
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.
Sep. 9. 2013 10: 22AM Modern Plumbing No. 1759 P. 1
Plumbing Permit Application
Building Fixtures l l OFIlrl: tsi ONlY.
l .,-.. 1�'d ceived n
City of Tigard ,Achy: ? /a /3 � Permit No.: Pte/./p/3-d0 3/y
j.1 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 9 2013 Plan Review
: =is: Phone: 503.639.4171 Fax 503.598.1960 Date/13y: Other Permit No,:
r t U A it a Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: 'uric el See Page 2 for
Internet: www.tigard•or.gov NolifiedlMelhod: Supplemental Information
TYPE Ott WO SfUhI
FEE* SCHEDULE
-
❑New construction ❑Demolition For specialhjornraflon use checklist.
Description I Qty. I Es. I Total
0 Addition/alleration/rcplaccmcni ❑Other: New 1-2-family dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUCTION SPR(1)bath 312.70
VI 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi•family SPIt(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Piro sprinkler(, ,sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
i 1 Catch basin or area drain 18.76
p1 I Job site address: ID q•s .51i 1 1 (,-k.
City/State/ZIP: '� Drywall,leach line,or trench drain 18.76
0u00`"` ` l 5 d 0 4`1 .D 3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 1w-0 ic 1c a Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Sp0 Rain drain connector 18.76
X6� Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear fl.:,_J Page 2
Water service(no.linear R.: 3 Page 2
Subdivision: I Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow premier 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
r r r Clothes washer 25.02
Dishwasher f I 25.02 D col
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank _ 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: • Nose bib 25.02
Phone;( ) I Fax:( ) Ice maker l 12.51 17-c I
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Contact name:
Primer 12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory ! 25.02 D
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) I Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
AA n ater heater 37.52
Business name:I v\0 Ae rrt T) M-�O 1 v� Co C • Water piping/DWV 56.29
VAddress: 1 1( 1 v _ s t�ti u,Ny,rl (i q-3 Other. 25.02
City/State/ZIP: t r►"( {'(A_ 04. -t Ob- Subtotal 6 7 SS
Phone:( ) loot l to Ho Fax:GO.__ (0q 1 te)-1`l I Minimum permit fee: $72.50 -J 7,$ t
Plan review (25%of permit fee)
CCB Lie.: --i q 06 Plumbing Lie.no.:3%1 p J?e
Slate surcharge(12%of permit fee) E3 D
Authorized signature: L `
L 1"LL TOTAL PERMIT FEE 71.a 0
Print name 41 /v,� L if Date; q��13 This permit applieation expires If a permit is not obtained within 180 days I
rx�r w,sb after It has been accepted as complete. ,/�
*Fee methodology set by Tri-County Building Industry Service Board. 00 YY
1:1Bulidlna lPerrnhr\PLMU-PennilAppdoe 10/01/09 440 A6167(1Nes/COMIW2a)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10957 SW 118TH CT, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
2013-10-24 00:00:00
PLM2013-00314
PASS - No C of O
Violation Summary:
Inspector Contractor
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 do 1 ;i\ ,.
Inspection Requests (24 Hrs.): (503) 639 -4175 ' I L I t hi of -coy/
INSPECTION WORKSHEET FOR DATE: / ` 17.,_ /3 TIME: PAGE:
SITE ADDRESS: ! 6 7 tic) 9 id II?( Lot-- 91 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description , # Contact # Message
350 5i7 C_- -r,,
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0 a4 L j i 1 :if L` — S 7-r%C i Z_
Corrections /Comments /Instr ons•
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
0 fAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspect.- Date:/-Z - 1 Phone #: (503) 718-075
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