Permit p CITY OF TIGARD PLUMBING PERMIT
11 11 ' COMMUNITY DEVELOPMENT Permit #: PLM2013 -00405
T [ G AA D 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 12/02/2013
Parcel: 2S 104CD09201
Jurisdiction: Tigard
Site address: 13574 SW MINT PL
Project: Duncan Subdivision: HILLSHIRE ESTATES NO 2 Lot: 91
Project Description: Installation of solar hot water drainback system.
Contractor: NORTHWEST WATER WORKS Owner: DUNCAN, BONNIE
40110 SE MEADOW SONG RD 13574 SW MINT PL
SANDY, OR 97055 PORTLAND, OR 97223
PHONE 503 - 314 -1470 PHONE: 503-590-7366
FAX: 503 - 668 -0375
FEES
Quantity Description Date Amount
1 ea Solar Units (Potable Water) 12/02/2013 $62.54
Specifics: 1 12% State Surcharge - 12/02/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 12/02/2013 $9.96
Plumbing
Class of Work: ALT
Type of Const: VB
Occupancy Grp: R -3
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 'cation Ce r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or dir t questions to OU alli 503.232.1987 or 1.800.332.2344
Iss ed By: K 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.
v 06 13 10 :15p Northwest Water Works 503-668-0375 p.1 k;
Plnmbins= Permit Application
RECEIVED
Site Utilities NOV X3.2013 _ 1011 (1FFICI. (.311 0\I.ti
•
City of Tigard jp__ ., /• R� /1 4l- rmittvo_: °
13125 SW Hall Blvd., Tigard, OR 972� �Y ®F TIGAR r Pc O Y/l -3`e0 �•'
: 0 . P hone: 503.718.2439 Fax: 503 598. �l PlaoBeviea � L
Inspection in 5036394175
on e: .. = d�Tl. Other Permit N • _ 3 DD
iAup
Internet: „, „.ti BUILDI DIVISIl .:,�a.:. :y hair: IS Sec Page 2 for
g ird- nr. Ivotifrd/Mdbed 77 (� Suppkmental Information
. TYPE OF WORK . . . FEE. SCREWLE
❑ New construction ❑ Demolition For spedal information hale checklist
Description I Qty. I Ea. I Total
® Additiom'alteration/replacement ❑ Other. New 1- 2-&mlly dwellings (includes 100 ft. for each utility connection)
• . CATEGORY OP CONSTRUCTION SFR (1) bath 312.30
® t- and 2- family dwelling ❑ CommerciaVindustrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 50032
❑ Master builder additional bath/kitchen 25.02
❑ Other. Fire sprinkler (_ sq. ll.) - . Page 2
JOB' SITE INFORMATION AND LOCATION. . Site unTities:
Job site address: 13574 SW MINT PL Catch basin or arse drain I 1836
Ciry /State/ZIP: Portland OR 97223 D7^A leach line, trench drain 1876
Footing drain (no. linear ft.: _,_) Page 2 •
Suite/bldg./apt. no.: I Project name: Duncan Residence Mmlofachuedhome uidiocs 50.03 '
Cross street/directions to job site: SW Boxelder St & SW Mint P1 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: __) Page 2
Strain sewer (no. linear R: _) Page 2
Water service (no. linear ft.: _) _ Page 2
Subdivision: Wilshire Estates NO.2 I Lot no.: 91 Fixture or item:
Tax map /parcel no.: 2S104CD09201 Backflow preventer f k 3127
DPSCRIpTLON OF WORK _ Backwatervahe 1251 •
Install of a solar hot water drahlback system
Clothes washer 25.02
Dishwasher 25.02 '
•
Drinking fountain 25.02 •
Ejectors/sump 25.02
•
® PROPERTY OWNER . I ❑ TENANT . Expansion tank 12.51
Name: Bonnie Duncan Fixwrrlserrer cap 25.02
Address: 13574 SW hUNT PL Floor drain/floor sink/hub 2$,02
Garbage disposal 25.02
City /State/ZIP: Portland OR 97223 Hose bib 25.02
Phone: (503)590 -7366 Fax: ( ) Ice maker 12.51
❑ APPLICANT ® CONTACT PERSON interceptor /grease trap 25.02
Business name: One Energy Mcdlwl gas (vain= S ) Page 2
Contact name: Megan Thomsen - Primer 12 51
Roof drain (commercial) 12.51
Address: 10260 SW Greenburg Rd #400 Sink/basin/lavatory - 25.02
CirylState/ZiP: Portland, OR 97223 Solar units (potable water) I 62.54
Phone: (602) 889 -8619 I Fax: : (602) 437 -4739 Tub/shower/shower pan 12.51
E -mail: megan.thomsen ®beoneenergy.com Urinal 25.02
' CONTRACTOR • Water closet 25.02
• Water heater 37.52
Business name: Northwest Water Wogs
Water piping/DWV 1 56.29
Address: 40110 SE Meadow Song Rd Other. 25.02
City /State/ZIP: Sandy, OR 97055
Subtotal
Phone: (503) 314 -1470 Fax: (503) 668-0375 Minimum permit fee: $7250
I
revi
CCB Lic.: 113197 Plumbing Lic. nog 3 -333PB Plan ew (25% of permit fee)
` State surcharge (12 %ofpermit fee)
Authorized sigmttd� vz TOTAL PERMIT FEE I
Print name: Melissa Newberry Da 11/5/13 Thla permit application expires if a perndt Is not obtalaed within 180 days
after It has hem aoeepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
I Bti]dmePermits'PLMU.PemltApp.da: ICOI/0e 440•4616T(lonv DM/NEa)