Permit (42) �,� CITY OF TIGARD PLUMBING PERMIT
2 . COMMUNITY DEVELOPMENT
11,11
Permit#: PLM2016-00417
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/09/2016
Parcel: 1 S134DA01400
Jurisdiction: Tigard
Site address: 11095 SW 106TH AVE
Project: Burrell Subdivision: NORTHERN PINE Lot: 5
Project Description: Replacing water heater.
Contractor: NORTHWEST HOME RENOVATION LLC Owner: BURRELL,AMANDA
11125 SW 106TH AVE 11095 SW 106TH AVE
TIGARD, OR 97223 PORTLAND, OR 97223
PHONE: 503-267-5552 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 08/09/2016 $37.52
Specifics: 1 12%State Surcharge- 08/09/2016 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment- 08/09/2016 $34.98
Class of Work: ALT Plumbing
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: •ermittee Signatur
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 ,4.V:
Fill �
City of Tigard g. „k `� Received
a 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: f l/ o.:
I PermitNify f v IPt 7
IN
Phone: 503.718.2439 Fax: 503.598.1960A Plan Review
AOther Permit No.: (� L Y7. �
T 1 G A R D Inspection Line: 503.639.41754ax: G 9F' DateBy:
Internet: www.tigard-or.gov Date Ready/By: Juris See Page 2 for
i � Notified/Method: �(w Supplemental Information
TYPE OF WORT '� ` ' FEE* SCHEDULE
❑New constructio ; .
n
For s ecial information use checklist
Description Qty, Ea. Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
/1 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:11095 SW 106th Ave Catch basin or area drain 18.76
City/State/ZIP:Tigard,Or 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Burrell
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
Replace water heater Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER } 0 TENANT Expansion tank 12.51
Name:Amanda Burrell Fixture/sewer cap 25.02
Address:11095 SW 106th Ave Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223
Hose bib 25.02
Phone:(503)380-0008 Fax:( ) Ice maker
® APPLICANT12.51
0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Northwest Home Renovation Medical gas(value:$ ) Page 2
Contact name:Steve Purves Primer 12.51
Address:11125 SW 106th Ave Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)380-0008 I Fax::( ) Tub/shower/shower pan 12.51
E-mail:steve@nwhomerenovation.com Urinal 25.02
CONTRACTOR Water closet 25.02
Business name:Northwest Home Renovation Water heater 1 37.52 37.25
Water piping/DWV 56.29
Address:11125 SW 106th Ave
Other: 25.02
City/State/ZIP:Tigard,OR 97223 Subtotal 37.25
Phone:(503)380-0008 Fax:( ) Minimum permit fee: $72.50 7a.:>---1,
CCB Lic.:201587 Plumbing Lie.no.: �/C 1 Plan review (25%of permit fee)
Authorized signatur
State surcharge(12%of permit fee) 70
TOTAL PERMIT FEE 77.ael
I Print name:PB1641 Date:7/25/2016 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
IBuilding\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
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
11095 SW 106TH AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00417
Don Sylvester
Violation Summary:
Inspector Contractor