Permit (15) CITY OF TIGARD PLUMBING PERMIT
•
a COMMUNITY DEVELOPMENT Permit#: PLM2014-00129
Ti G A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2014
Parcel: 2S102AB00910
Jurisdiction: Tigard
Site address: 12145 SW 92ND AVE
Project: LARSON Subdivision: KIMBERLY ADDITION Lot: 10
Project Description: Replacing water piping,(1)pressure reducer valve,(1)water heater,and(1)expansion tank.
Contractor: OWNER Owner: LARSON,ALEC E
ALEC LARSON 12145 SW 92ND AVE
12145 SW 92ND AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-706-8902 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Expansion Tank 04/24/2014 $12.51
Specifics: 1 ea Water Piping/DWV 04/24/2014 $56.29
25 Misc Other Fee 04/24/2014 $25.02
Type of Use: SF 1 ea Water Heater 04/24/2014 $37.52
Class of Work: ALT 1 12%State Surcharge- 04/24/2014 $15.76
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $147.10
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: )7473,„1„,,,<
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 Applicat gICEIV l l
Building Fixtures xx I t)It t)rl I( I. I ,,► OM.1
City of Tigard Received
• D an Lt/ �Lf Ai _ Permit No.: L��Iy Ie(i
lig
13125 SW Hall Blvd.,Tigard,OR 97j R 4 2014 y
. Plan Review
Phone: 503.718.2439 Fax: 503.598.1960
Date/By: Other Permit No.: at L241 Y 00M0
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By. Juris HI See Page 2 for
Internet: www.tigard-or.gov 1 Notified/Method 'f Supplemental Information
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❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-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:12145 SW 92ND AVE Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site:CENTER 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.:_) Page 2
Subdivision:KIMBERLY ADDITION 1 Lot no.: 10 Fixture or item:
Tax map/parcel no.:2S102AB00910 Backflow preventer 31.27
DESCRIPTION OF W Backwater valve 12.51
.. Clothes washer 25.02
REPLACE EXISTING FRESH WATER PLUMBING Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
t 1 4,0 ..1 " .n t 'e :t 1. ,V Expansion tank / 12.51 /2. s-/
Name:ALEC E LARSON Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12145 SW 92ND AVE
Garbage disposal 25.02
City/State/ZIP:TIGARD,OR 97223 Hose bib 25.02
Phone:(503)706-8902 Fax:( ) Ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52 37-Sid.
Business name: i Water piping/DWV 'l 56.29 .A
Address: Other: PQI6 4fjjuwEQ VO}L'' / 25.02 d,5',
City/State/ZIP: Subtotal 13/, 31
Phone:( ) Fax:( )
Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: lumbing Lic.no.: State surcharge(12%of permit fee) s 7(0
Authorized signature: TOTAL PERMIT FEE �47 7• /0
Print name: Date: Z This permit application expires if a permit is not obtained within 180 days
(,,2 L Lac,C n y 3 J/ y after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)