Permit CITY OF TIGARD PLUMBING PERMIT
I . COMMUNITY DEVELOPMENT Permit#: PLM2013 00363
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2013
Parcel: 2S 111 DC 12200
Jurisdiction: Tigard
Site address: 15910 SW OAK MEADOW LN
Project: BROWN Subdivision: SUMMERFIELD NO.11 Lot: 618
Project Description: 50 ft.of water service.
Contractor: 3 MOUNTAINS PLUMBING Owner: BROWN, C DAVID&PATRICIA
524 N TILLAMOOK ST 15910 SW OAK MEADOW LN
PORTLAND, OR 97227 TIGARD,OR 97224
PHONE: 503-670-1342 PHONE:
FAX: 503-828-0515
FEES
Quantity Description Date Amount
50 If Water Service 10/16/2013 $62.54
Specifics: 1 12%State Surcharge- 10/16/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/16/2013 $9.96
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 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.
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Issued By e. Permittee Signature: ''' / i
all, i
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.
From:Bill Kerrigan Fax:(503)765-5512 To: Fax: +1 )503)598-1960 Page 3 of 3 10115/2013 10:20
Plumbing Permit Application.
Site Utilities , -i'
Received
IIIII - City of Tigard o u << ?e Dale/By, /d 15- I'3 /j 7- Permit Nn.:® go I -,. U10 3'6 j
13125 SW Hall Blvd.,Tigard,OR 47223 flan Review
Phone: 503.718.2439 Fax:,503.598_1960 ••, ` Date/By Other Pen it Na
T I G A R D Inspection Line: 503.639.417<5;,t `�. _, J Date Ready/By- t - ®See Page 2 for
Internet: www.tigard-or.gov'n-' �,",,"^".--; '-";Or''- Notified/Method' Supplemental Information
TYPE OF•WORK FE • SCHEDULE
❑New construction ❑Demolition For special information use checklist.
• Description I Qty. I Ea. 1 Total
0/Addition/alteration/replacement• ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
d1-and 2-family dwelling ❑Commerciallindustrial SFR(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.ft.) Page 2
' • JOB SITE INFORMATION AND LOCATION Site utilities;
Catch basin or area drain 18.76
Job site address: /69/v &) af}tC. M CADow 1--13 -
Drywell,leach line,or trench drain 18.76
City/State/ZIP: atT,A..„() be_ C7,2 e/
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: artivuisi Manufactured home utilities 50.03
Cross street/directions to job site: U4K. 1 ne,, D kN:., 6i.,N &-gtos ?o Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear R.:_) Page 2
Water service(no.linear R.: Si-)) 1 Page 2 co2.St(
Subdivision: Lot no.: Fixture or item:
fax map/parcel no.: Backflow preventer 31.27
Backwater valve 12 51
DESCRIPTION OF WORK
Clothes washer 25.02
gr21,4C1 A 3)6N iJRrf2 6E-17-AWE Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
L+J PROPERTY OWNER l ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
rfTie tc 1 p I�¢G1 1.� Floor drain/floor sink/hub 25.02
Address: /$5/0 ) 0014. ulcjt,7ol3 Lo Garbage disposal 25.02
City/State/ZIP: 1-.o¢T,4r1n C1Z 97 old"' Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12 51
' 'dAPPLICitNT Ei CONTACT PERSON Interceptor/grease trap 25.02
;� Medical gas(value:$ I Page 2
Business name:
uloua-rata� 1iamitr,►l, Primer 12.51
Contact name: LAtlec+d Carr,' Roof drain(commercial) 12.51
Address: Sa/N7litM4eK- Li- Sink/basin/lavatory 25.02
City/State/ZIP: nLzTt_ r7
Oa 9 7,2)7 Solar units(potable water) 62.54
Phone:(S03 ) ta")0 -13y
Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: IkcrGn0 3omoctaEA%its
. PIJmlOrr141•C.Otrr Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: A '40gNralyd$ --pu)t-_ I' , Waterpiping/DWV 56.29
Address: s94 N Trith*AOOL• ST Other: 25.02
Subtotal Lr .S4/
City/State/ZIP: I�oa-ru�..x. b� 97a;�
Minimum permit tee. $72.50 7A.Z
Phone:(S03 ) 67e-13 s. Fax:( )
Plan review (25%of permit fee) '---
CCB Lie.: Plumbing Lic.no.:
1(���q - yti• State surc6arge(12%of permit fee) '70
Authorized signature // TOTAL PERMIT FEE ,�
Print name: J �.etw�- This permit application expires if a permit is not obtained within ISO days
l.4cn) 1tt.EEr.1 Date: /D`i5/�01 after it has been accepted as complete.
I r
'Fee methodology set by Tn-County Building Industry Service BuwJ
P\andding\PmmtsWLMU-PermitApp doc 10/01,09 440-4010rl to,02/COM/WCD)