Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit#: PLM2013 00345
T[G AR-D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2013
Parcel: 2S102CA00919
Jurisdiction: Tigard
Site address: 13285 SW VILLAGE GLENN DR
Project: SWANDA Subdivision: VILLAGE GLENN Lot: 19
Project Description: 50 ft.of water service.Electrical permit may be required if replacement piping affects house grounding.
Contractor: 3 MOUNTAINS PLUMBING Owner: SWANDA, MICHAEL EDWIN
PO BOX 230051 CHERYL A
PORTLAND,OR 97281 13285 SW VILLAGE DR
TIGARD,OR 97223
PHONE: 503-670-1342 PHONE:
FAX: 503-828-0515
FEES
Quantity Description Date Amount
50 If Water Service 10/02/2013 $62.54
Specifics: 10 ea Minimum Fee Adjustment- 10/02/2013 $9.96
Plumbing
Type of Use: SF 1 12%State Surcharge- 10/02/2013 $8.70
Plumbing
Class of Work: ALT
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 •/
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the r - -:opted by . e Or .f'
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ay obtain a copy •f th- les
or direct questions to OUNC by calling 503.232.19: • .800.3
Issued By: ee 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.
Plumbing Permit Application
Site Utilities 19 FOR OFFICE USE ONLY
City of Tigard "`' "`'J Permit No.
y L)i /liy 2a . i p ay 13_003 5-
a 13125 Phone:SW Hall .2439 Tigard,50 r� `� Plmm Re,,e,
Phone 503.718.2439 Fax: 503.- 6U tot Dane/liy Usher Permit No
Inspection Line: 503.639.4175 C AA _` Date I(ealJ�/Ii■ limb
TI GARB Internet: www.tigard-or.gov OC� ��Gr��`` Nulilie t/Method �3 ! ® tiec Page 2 for
j!„ , ay Supplemental Information
TYPE OF WORK 0.0%616 `t' FEE* SCIIEDULE
❑New construction ❑ D( t It For special infurntation use checklist.
�QQ� Description I Qty. I Ea. I Total
[Addition/alteration/replacement ❑&ier: New I-2-Wilily dwellings(includes 100 II.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)path 312.70
IH1/I-and 2-family dwelling ❑Commercial/industrial SIR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑ Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other:
Fire sprinkler( sq. II.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
�3a8s 51,3 VILLRGE GLE,).1�z
1)rywell,leach line,or trench drain 18.76
City/State/ZIP: 17-
6arzr., ce_ 97 .93
Footing drain(no.linear II.: ) Page 2
Suite/bldgiapt.no.: I Project name: C
J(4[ Manufactured home utilities 50.03
Cross street/directions to job site: NEAR_ CoetJEZ OF,SW /}Sol AWE AAJD Manholes 18.76
1-)E
-
Sanitary Si,..) 1/1 LU3-C,E CLC1...4 J Rain drain connector 18.76
Sanitary sewer(no.linear IL:_) Page 2
Storm sewer(no.linear ll.:_) Page 2
Water service(no.linear lt.• 50) 1 Page 2 (a SO
Subdivision: 1 Lot no.: Fixture or item:
fax map/parcel no.: 13ackllow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
1Soel,JL, ti.1E1J WATEe 5£ef1C,.F_ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: � ` C Fixture/sewer cap 25.02
�iv-E A..11, t,..t!•EZcL 0p.0 OA
Floor drain/floor sink/hub 25.02
Address: /3,85 6p3 VILLAc1c GLE.JAJ-ba Garbage disposal 25.02
City/State/ZIP: Tc,Ae_D O2 q7 aPS hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT Er CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: S M , ,-m-1 JS M3tA1L_./ Primer 12.51
Contact name: LADE0,3 e1eEE�J
Roof drain(commercial) 12.51
Address: gal/ ,j Tit.44.1.4,064 ST Sink/basin/lavatory 25.02
City/State/ZIP: 1' e_arivrJ7 Ola q-7a -1 Solar units(potable water) 62.54
Phone:($05 ) &70- is q,p Fax: :( ) Tub/shower/shower pan 12.51
-L- Urinal 25.02
E-mail: IAArena,3 mnun�Atns-plmrn-ti noA.Coro
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: 3 iMo.imt, s RuMi3lp Water pipinJlWV 56.29
Address: 6014 1 . --too .. sr Other: 25.02
City/State/ZIP: IJoeroktx,t> C)IZ R-139 i Subtotal it 50
Phone:( 503 ) (y-to- 1342 Fax:( ) Minimum permit lee: $72.50 •��)
m Plan review (25%ofpermit fee) -
CCB Lie.: /Ly,9,/q 9 Plumbing Lic.no.:. -1.7- flA�q
9 State surcharge(12%of permit lee) I.-70
Authorized signature: WI till 'TOTAL PERMIT FEE 8 Lit
This permit application expires if a permit is not obtained within 1811 days
Print name: A.oce-,j CREED Date: /o/ //JZO 3 after it has been accepted as complete.
"Fee methodology set by'fru-C'ounty Building Industry Service Board.
I:t Building\PermiIs\PLMU-PermitApp doc 10/01/09 440-4016T(I 0/02/('UM/WIO13)
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
13285 SW VILLAGE GLENN DR, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
2013-12-31 09:22:00
PLM2013-00345
PASS - No C of O
Violation Summary:
Inspector Contractor