Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2014-00148
T[G.A A..1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/07/2014
Parcel: 1S133AD14200
Jurisdiction: Tigard
Site address: 12767 SW SORREL DOCK CT
Project: MINYAN Subdivision: SUMMER LAKE Lot: 23
Project Description: Replacing existing tub and tub/shower.
Contractor: VENNE PLUMBING LLC Owner: MINYAN, DANYA M&GOLAN
15145 SW DIVISION ST 12767 SW SORREL DOCK CT
SHERWOOD,OR 97140 TIGARD,OR 97223
PHONE: 503-624-9309 PHONE:
FAX: 503-684-0940
FEES
Quantity Description Date Amount
2 ea Tub/Shower/Shower Pan 05/07/2014 $25.02
Specifics: 1 12%State Surcharge- 05/07/2014 $8.70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment- 05/07/2014 $47.48
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.
Issued By: Permittee Signature:
''
Call 503.639.4175 by 7:00 a.m.for the next available inspectio datL.
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
cSite-titifitiENT t t�� I t I I: t 1 I I I( I I -,I 11\I 1
City of Tigard y e
DatB
Date/B : PIM CZ ' / .V .'. v V
II 13125 SW Hall Blvd.,Tigard, .` ' '
is -
' Phone: 503.718.2439 Fax: 51' '..1960 %1'1 Plan Review Other Permit No.:
1 I i. n R v Inspection Line: 503.639.4175 6� Date Ready/By: )uric: 0 See Page 2 for
Internet: www.tigard-or.gov NO „Ca" Notified/Method: 7 Supplemental Information
TYPE•OF WORK ►1.- V N.0 FEE* SCHEDULE .
❑New construction ❑ 1 •.°Inliallillin For special information use checklist
Descri t tion • . Ea. Total
AAddition/alteration/replacement I . New 1-2-family dwellings(includes 100 ft.for each utility connection) •
1.CATEGORY OF CONS`l ;'T70N SFR(1)bath 312.70
A 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
❑Accessory building El Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
2I(p 1 st,0 Catch basin or area drain 18.76
Job site address: � Sorrel 1 Eck e�
City/State/ZIP: 'T ICa q�p �_ 1, 912-"Z:3 Footing drain line,lior near trench drain 18.76
e 2
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: ti01.,411\j
I N y4A1 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.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
• DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
R- 't.PrC I N(i -)X l9f I N L, Ili is W rrif 1.1c-:_‘,01-140 Dishwasher 25.02
l t . - It Tuqs 1'j_ I t 1"1P►tis. , Drinking fountain 25.02
Ejectors/sump 25.02
KPROPERTY-OWNER I ❑ TENANT Expansion tank 12.51
Name:
&.61...„ ) Fixture/sewer cap 25.02
1' I Floor drain/floorsink/hub 25.02
Address: 121D 7. �r�` DOGE C"? -
Garbage disposal 25.02
City/State/ZIP: T((d./'►L-p OR- a'?ZZ 3 Hose bib 25.02
Phone..( ) Fax:( ) Ice maker 12.51
. _ - •. ❑ APPLICANT CONTACT PERSON Interceptor/grease trap 25.02
Business name: V'e'N V L A A Mi t&)N L1 Medical gas(value:$ ) Page 2
Contact name: •LVpstij. V Na Primer 12.51
Roof drain(commercial) 12.51
Address: `CJ'l{Gf sct,0 I)tv1 4 0 N sr- Sink/basin/lavatory 25.02
City/State/ZIP: ea,.. i ,i,r li(Jd4, A] ell 1' O Solar units(potable water) 62.54
Phone:(C5 Gj l "1 . 5 o D2 Fax: :( )(0 8 ti - 69 L( Tub/shower/shower pan 12.51 OA
E-mail: Yvan e �Y�rI.I'i pU441bl� •CA 1 Urinal 25.02
` CONTRACTOR '�( Water closet 25.02
��c•-�.��t L,p Water heater 37.52
Business name: .J G 1�I v C IV ti I N Cs Water piping/D W V 56.29
Address: t 7 , IV 1&l o(u S1 Other: 25.02
City/State/ZIP: mar) crL 011 LID Subtotal 02;:(...Ji-
Phone: J) (0214 -i30 9 Fax:06:5)(pi ti -00 LI U Minimum permit fee: $72.50 '72. 0
CCB Lic.: ` O(2 14 D!L../ Plumbing Lic.no.: Pg, °�56 Plan review (25%of permit fee) r
State surcharge(12%of permit fee) $•`7 b
Authorized signature: TOTAL PERMIT FEE ¶'I.2_0
Print name: D s4 \MN Date:£j •4.`t,/ii This permit application expires if a permit is not obtained within 180 days
1` 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(I0/02/COM/WEB)