Permit CITY OF TIGARD PLUMBING PERMIT
14 Ai
a COMMUNITY DEVELOPMENT Permit#: PLM2013 00396
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/04/2013
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Parcel: 1 S134CD00300
Jurisdiction: Tigard
Site address: 11995 SW KATHERINE ST
Project: YOUNCE Subdivision: LERON HEIGHTS NO.3 Lot: 73
Project Description: Repiping entire house and replacing 50 ft.of water service.
Contractor: DAVIS PLUMBING Owner: LULA YOUNCE
16008 SE SOUTHVIEW AVE 11995 SW KATHERINE ST
MILWAUKIE,OR 97267 TIGARD,OR 97223
PHONE: 503-307-1920 PHONE:
FAX:
FEES
Quantity Description Date Amount
50 If Water Service 11/04/2013 $62.54
Specifics: 1 ea Water Piping/DWV 11/04/2013 $56.29
1 12%State Surcharge- 11/04/2013 $14.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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:
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
Building Fixtures TOR-OFFICE USE ONLY
Received
74 City of Tigard `i Date/By: J J/y ,-„- Permit No.:/ /1 o/3-Do 3q(1
v 13125 SW Flail Blvd.,Tigard,OR'ili, �g Plan Review
Phone: 503.718.2439 Fax: 503.i':'. ieP Other Permit No.:
• \J Date/By:
T I G A R D Inspection Line: 503.639.4175 Ov �Q Date Ready/By: Juris: See Page 2 for
Internet: www.tigard-or.gov N � QO Notified/Method: Supplemental Information
TYPE OF WORK % ei \k k ,Ni FEE* SCHEDULE
❑New construction ❑ Da For special informalion use checklist
..1_14.11_
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ • er: New 1-2-family dwellings(includes 100 ft-for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
271-and 2-family dwelling ❑Commercial/industrial 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:
Job site address: f Rq5 5w o,`f't 1 n S /- Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: ,,�d4� �� GJ'
J Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: y v(/WI ej�' Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:5()) 1 ! Page 2 41,g/
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31-27
Backwater valve 12.51
DESCRIPTION OF WORK
+ � , t Clothes washer 25.02.
W ii lL ��V� "rely) re, Dishwasher 25.02
W V S rvi t - Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I El TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Davis Plumbing Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Ross Davis
Roof drain(commercial) 12.51
Address: 16008 Southview Sink/basin/lavatory 25.02
City/State/ZIP:Milwaukee OR 97267 Solar units(potable water) 62.54
Phone:(503)3071920 I Tub/shower/shower pan 12.51
Urinal 25.02
rdavisplumbing@gmail.com
Water closet 25.02
CONTFtACTOR
Water heater 37.52
Davis Business name: ' Water piping/DWV I 56.29 5-Z,
Address: i Other: 25.02 1
City/State/ZIP:Milwaukee OR 97267 Subtotal
I 3071920 Fax:(503)5498970 Minimum permit fee: $72.50 ///�,83
Plan review (25%of permit fee) ___..
I Plumbing Lic.no.:3558pb o
III
State surcharge(12%of permit fee) /it 1-
Authorized signature TOTAL PERMIT FEE /33
a
This permit application expires if a permit is not obtained within 180 days
Print name op�J ingl i D •I n after it has been accepted as complete.
• w *Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46t6T(10/02/COM/WEB)