Permit (2) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00028
Tigard OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 01/22/2013
TIGATIGARD 9
Parcel: 1 S125DA06300
Jurisdiction: Tigard
Site address: 9560 SW 69TH AVE
Project: Krochmal Subdivision: KINGS VIEW Lot: PT 49, F
Project Description: (2)lavatories,(1)tub(1)shower pan and(1)water closet
Contractor: STANDARD PLUMBING&HEATING Owner: KROCHMAL,CHERYL KAY
8318 SW SPRUCE 9560 SW 69TH AVE
PORTLAND, OR 97223 PORTLAND, OR 97223
PHONE: 503-244-0365
HONE: 503-246-3338
FAX:
FEES
Quantity Description Date Amount
2 ea Lavatories 01/22/2013 $50.04
Specifics: 2 ea Tub/Shower/Shower Pan 01/22/2013 $25.02
1 ea Water Closet 01/22/2013 $25.02
Type of Use: SF 1 12%State Surcharge- 01/22/2013 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: „ i „ Permittee Signature: ^ �
/j1LIA-k(
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 RIxEIVE
Building Fixtures
City of Tigard JAN 2 2 2013 Daate/Btveyd. (/a.a./13 Permit No.:()LAX)!3-}"
• 13125 SW Hall Blvd.,Tigard,OR 97223 p
Date/By:
: 0 Phone: 503.718.2439 Fax: 503.598.19600 TIGARD Plan Review
Other Permit No.:
T t( A R Inspection Line: 503.639.4175 BUILDING DIVISIO1Cr Method: '� Srrppkmental Information
Internet: www.tigard-or.gov
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑ Demolition For °^�OnO� 'hecklist
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
❑Accessory building SFR(3)bath 500.32
❑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:9560 SW 69m Catch basin or area drain 18.76
City/State/ZIP:97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:krochmal Manufactured home utilities 50.03
Cross street/directions to job site:South off Taylors Ferry Road 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.: Fixtare or Kern:Tax map/parcel no.: 1 SI 25DA f1631N) Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
bathroom Repair&Remodel Existing Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name:Cheryl Krochmal Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:9560 SW 69th
Garbage disposal 25.02
City/State/ZIP:Tigard/Oregon/97223 Hose bib 25.02
Phone:(503)244-0365 Fax:( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Standard Plumbing&Heating Co Inc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Don Alton
Roof drain(commercial) 12.51
Address:P.O.Box 19205 Sink/basin ) 2. 25.02 50.04
City/State/ZIP:Portland/Oregon/97219 Solar units(potable 62.54
Phone:(503)246-3338 Fax: :(503)244-1279 Tub/shower/ ower pan 2 12.51 25.02
E-mail:Don9erta)comcast.net Urinal 25.02
Water closet 1 25.02 25.02
CONTRACTOR
Water heater 37.52
Business name:Standard Plumbing&Heating Co Inc Water PPS
l WV 56.29
Address:P.O.Box 19205 Other: 25.02
City/State/ZIP:Portland/Oregon/97219 Subtotal
Phone:(503 )246-3338( Fax:(503)244-1279 Minimum permit fee: $72.50 100.08
CCB Lie.:7309 t + 1 Li Plumbing Lic.no.:26-72PB 111 (l Plan review (25%of permit fee)
` State surcharge(12%of permit fee) 12.01
Authorized signature: TOTAL PERMIT FEE 112.09
r
Pont name:Donald .Alton Date:]1/22/2013 II. permit applcadon expires if a permit is not obtained within 100 days
after it has been accepted as complete.
'Fee methodology set by Tel-County Building Industry Service Board.
I:\BuildmgiPermits\PLMU-PermtApp.doc 10/01/09 440 46t6T(tn02/COM/W®)