Permit (14) CITY OF TIGARD PLUMBING PERMIT
,111
: COMMUNITY DEVELOPMENT Permit#: -
PLM2016 00459
TARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/30/2016
II
Parcel: 1S135CD02000
Jurisdiction: Tigard
Site address: 11760 SW 98TH AVE
Project: KRAWCZYK Subdivision: GREENBURG HEIGHTS ADDITION Lot: 3
Project Description: Repipe house for water supply and waste
Contractor: BRYAN&MEGAN KRAWCZYK Owner: BRIAN KRAWCZYK
11760 SW 98TH AVE 11760 SW 98TH AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-758-3507 PHONE: 503-758 3507
FAX:
FEES
Quantity Description Date Amount
2 ea Water Piping/DWV 08/30/2016 $112.58
Specifics: 1 12%State Surcharge- 08/30/2016
Plumbing $13.51
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $126.09
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. - on OUNC . calling 503.232.1987 or 1.800.332.2344.
Issued =y:
Permittee Signature:
AP
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 Applin ` , q ,
Building Fixtures
FOR OFFICE [SE ONLY
City of Tigard AUG 3 0 7 O l Fi Received
11413125 SW Hall Blvd.,Tigard,OR 97223 Date/By: /& Permit No.: iL���/�-700g 4 II
Phone: 503.718.2439 Fax 503 598�190 r �ro (;p Plan Review
1 v rl Date/By: Other Permit No.: if S?
Inspection Line: 503.639 4175 i/ C /IO�J�
I'I G K D r m r^ r Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gc ii l F_ ii1A 4.n s'v d
ob
� _ , Notified/Method:
;� r �° ° ,. -ti fin° '05'.4;
,�, � Supplemental Information
. , •.
0 New construction ❑Demolition For special information use checklist
►,1 Addition/alteration/replacement Description I Qty. � Ea. � Total
Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
- "` ►sjr i . •t)t : r C SFR(1)bath
, :.. 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath
437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
tt i,` r r
� 3 t'` * Site utilities:
Job site address:11760 SW 98th Ave Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: I Project name:Plumming Replacement Footing drain(no.linear ft.:_) Page 2
Manufactured home utilities 50.03
Cross street/directions to job site:South of Pihas Street Manholes
18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Subdivision: Water service(no.linear ft.:_) Page 2
I Lot no.: Fixture or item:
Backflow
Tax map/parcel no.:1 S135CD02000 preventer 31.27
fi•
..,:c Backwater valve 12.51
Replacement of supply,and waste plumbing lines Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump
25.02
ft ?'t, r k " ( Expansion tank 12.51
Name:Bryan&Megan Krawczyk Fixture/sewer cap 25.02
Address:11760 SW 98th Ave Floor drain floor sink hub 25.02
City/State/ZIP:Tigard,OR 97223 Garbage disposal 25.02
Hose bib 25.02
Phone:(503)758-3507 Fax ( )
i... ,u v Ice maker 12.51
Ii � r � � � �` Interceptor/greaseuap 25.02 x �
Business name: Medical gas(value:$ ) Page 2
Contact name:Bryan Krawczyk Primer 12.51
Address:11760 SW 98th 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)758-3507 Fax::( ) Tub/shower/shower pan 12.51
E-mail:bryankraw@gmail.com Urinal 25.02
,' a � e'•. 7, •` Water closet 25.02
Business name: /� Water heater 37.52 MIMI
ci Water piping/DWV A 56.29
Address:
Other: 25.02
City/State/ZIP:
Subtotal ilov 56.29
Minimum permit fee: $72.50 'li 5O•
Phone:( ) Fax:( )
Plan review (25%of permit fee) p
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%
Authorized signature: k '..?- g ( 2/°of permit fee) I3.57
` TOTAL PERMIT FEE i No,Qq
Print name: Y�"'� .r�...1 Lz/� ' Thispermit a lication ex tree if a permit is not obtained within 180 days
(' Date: � h� PP p'
U after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:A Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46161(10/02/COM/WEB)