Permit CITY OF TIGARD PLUMBING PERMIT
i111 1 ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00365
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2015
Parcel: 2S102BC04302
Jurisdiction: Tigard
Site address: 12975 SW GRANT AVE
Project: Kids Campus Subdivision: NORTH TIGARDVILLE ADDITION Lot: 30
Project Description: Plumbing re-pipe
Contractor: POWER PLUMBING CO Owner: SPRINGER-GEORGESON, KATHERINE
PO BOX 19418 GEORGESON,THEODORE
PORTLAND, OR 97280 PO BOX 766
SHERWOOD, OR 97140
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 10/22/2015 $56.29
Specifics: 1 12%State Surcharge- 10/22/2015 $8.70
Plumbing
Type of Use COM 16 ea Minimum Fee Adjustment- 10/22/2015 $16.21
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct qu ns to OTC b calling 503.232.1987 or 1.800.332.2344.
Issue By: Permittee Signatu
503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
OCT-20-2015 10:31 From: To:5035981960 Pa9e:1'2
Plumbing Permit Application
®
Building Fixtures EC C
City of Tigard Received
IN ty g 0 C T 2 0 2015 Date/By: �0 Zi Permit N�L/`1�d/c_ O36s
• L3125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503,718.2439 Fax: 503.5$ Other Permit No.:
Inspection Line: 503 639.4175 0�TIGAI3D ��NSy
riGnRn
r h T Date J,...,
for www hgard-orgv BUILDING DIVISION N�ti p�thod S a Dplemest.l Information
#f�Ckinna wfhtii 1 f11 4" r1 " 4 1oY �f?iiitil : U 1[r V! tI i ^t.1 lli∎ Ap. 4 , ,d •`k b4 ,� . [U 104t
. ' ill,,� ,,1,, lu„ ,. i r I j ?, " ,lItiY1 b )i , I,?, . , ., ° ,. fl, +.alb �ii,
❑Ncw construction ❑Demolition For special information use checklist
Description I Qty. I Ea. j Total
Addition/altcration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
r9rx7i�(lP i g tl l Y1:5 iiON, wt rjlO i,lP , C 7, 11+,I )'',�, r
,,; SFR,(1)bath 312.70
❑ I-and 2-family dwelling 711 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath . 500.32
0 Each additional bath/kitchcn 1 25.02
12 Master builder
Accessory building Multi faintly
❑Other: Fire sprinkler( sq.ft) Page 2
ilh,q;it�+bf+�.,"��i iiittQi',,rr B'�G91y��i�!q�,,�y��,t�,�.`�+{i �H i iir111,1 a YTr +; ---.
„,{t�1,�1P ' �Yi�+ a� `�'F'Y7Mfl"tY �ilyf?;��►�t;;.>1�D�ia�,�l� ����;+ 4r� '/'d1I ; tilts ntiRties:
Job site address: I ig7S 5(AJ (7-�_ /_L Catch basin or area drain 18.76
City/State/ZIP: --'n r d 0 117_'_3 Drywcll,leach line,or trench drain 18,76
�J / Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:1.</L_ ' elY/IPii..S Manufactured home utilities 50.03
Cross street/directions to job site: _Manholes 18.76
Rain drain connector _ 18.76
w - Sanitary Sewer(no.linear ft.:_) Page 2
"' - Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.'`) Page 2
Subdivision: Lot no.:
Fixture or item;
Tax map/parcel no.: Backtlow presenter MEM
,CYAw :` :;,V 1 /° y��i / , , AI 'iy i Q} x ,r +, r � ,! Da:kwater valve ... 12.51
_; R l l M+ i "' +"^9 ll =., I,,""'"V,' cy‘•i . J
Clothes washer 25.02
.._ �1 i l(-I'l'l b 1 kiGf IP 0.7/J,Q._ . __ Dishwasher 25.02
f / Drinking fountain
Ejectors/sump 25.02
r I rn�S4 lt1
0'?t Tf , AU�i ,..,, �.. i h r+ 1+ t; !.,,,,1 � Expansion
T� 4��..v h .... I f ,,,9 .rv:�
Ex p
ansion tank
Fix ure/sewer cap ap 25.02 Nam:
Floor drain/floor sink/huh 25.02
Address: Garbage disposal 25.02
City/State/71P: - Hose bib 25.02 is
Phone:( ) Fax
( Ice maker kenr
12.51
r�B4,^ +r4tM 1i u4i �, 1111 .�1 }d1,, �,�{k s *5W I , Inlerceptr! tease trR P 25.02
Medical gas(value:$ ) Page 2
Business name: 0n r I - 1 ,L 1• s Primer
Contact name: r 1
S►+P LJJ 4 J/ Roof drain(commercial) VI 12.51
Address: PO ,6 ox 1'/if I e Sinbainavatory
_
City/State/ZIP: O01Q Ot, pte 972 "1)
, Solar units(potable water) 62.54
Phone:(573) ay y_I q Fax::(93) e2 /L/ '8 , ' Tub/shower/shower pan 12.51
E-mail! e -� Urinal 25.02
vl• . I i .ef , � • ,
� 4r
,, water closet 25.02
r:;:,e,.,',0{t:"' 1` Y..,,t '- ., p,,:j4004611,,,, ,ll"."i
( ) Water heater 37.52
Business nantc: ro L(-)_eJL p vvi 6, not co _
Water pipinE/DW V I 56.29 9p,E9
Address: lit(p ,SW M�I�i9 G - 6/v4- �_ Other: 25,02
City/State/ZIP: 1p ✓ a..n d O e 77z 23 Subtotal ,29
Phone:(5'03) 0(,�(,r_t qao Fax:(�3) 1-ill_F$z� Minimum permit fee: 572.50 -7�.�-
Plan review (25%of permit fee) r
CCB Lie.: S 2,3-7 S- Plumping Lic,no.:3 ti•/57)e6
p State surcharge(12%of permit fee) ••• .1 0
Authorized signature: -t,,A.A c+tt yt1 S,_ S.I a il
TOTAL PERMIT FEE
4 /cs O,/5 �l'his permit application expires if a permit is not obtained within I80 days
Print name: V GE` S Date: after It has beta accepted as complete.
"fee methodology set by Tri-County Banding industry Service Board.
i 1i30n1dina\Rvma>,U't.MU-t'ermitApp.doc 10/01/09 440-4e 16T(10/02/COM/Wi-x)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12975 SW GRANT AVE, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
October 26, 2015 at 11:01:39
AM
PLM2015-00365
Don Sylvester
Violation Summary:
Inspector Contractor