Permit CITY OF TIGARD PLUMBING PERMIT
11 -i• COMMUNITY DEVELOPMENT Permit#: PLM2018-00442
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/20/2018
T i c;;`R D9 Parcel: 1S133DA03700
Jurisdiction: Tigard
Site address: 12545 SW GLACIER LILY CIR
Project: KRAAKEVIK Subdivision: AMART SUMMER LAKE Lot: 59
Project Description: Adding(1)clothes washer,(1)lavatory,(1)tub,and(1)water closet for laundry room and bath renovation.
Contractor: CORNELIU MORARIU PLUMBING Owner: KRAAKEVIK,JEFF&SUSAN
5235 SW 153RD AVE 12545 SW GLACIER LILY CIR
BEAVERTON,OR 97007 TIGARD, OR 97223
PHONE: 503-317-9659 PHONE:
FAX: 503-646-0941
FEES
Quantity Description Date Amount
1 ea Clothes Washer 09/20/2018 $25.02
Specifics: 1 ea Lavatories 09/20/2018 $25.02
1 ea Tub/Shower/Shower Pan 09/20/2018 $12.51
Type of Use: SF 1 ea Water Closet 09/20/2018 $25.02
Class of Work: ALT 1 12%State Surcharge- 09/20/2018 $10.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $98.08
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 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.FrEC F -
Building Fixtures 1OR Oil 11 1: t `si. ON1.1
City of Tigard S E 2 0 2018 Received 7 !F: , Permit No.: /7/4 / F7?JY�/1
I3125 SW Hall Blvd.,Tigard,OR 9 j2 i pian Re
6• Phone: 503.718.2439 Fax: 503. .1960~' Datorg view Other Permit iNo.:
1 1 ',RD Inspection Line: 503.639.4175 BUILDING E,..�i\,',,:. ;; Date Ready/By: Juris: fid ace Page 2 for
Internet: www.tigard-or.gov Notified/Method: S plemental Information
Rd*****::.-
�x ,ems H Y, ,p �`of _ .�%^ r c k�itk .h. r c..-e ,%F i:,:''-:,, is
CWItl
1:1 New construction 0 Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
^:r Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
" - ` `1 ;;: ..A.5^ o�... e3 a t .- - ....%,,,,'<n SFR(])bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
e . :,'a < ra`- °:. ,+ate �ry ,!1: Site utilities:
7 Catch basin or area drain ! 18.76
Job site address:
59C 3w 6--MC/�.� Z,/
Drywell,leach line,or trench drain 18:76
City/State/ZIP: -1;;;, PCZ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: k--0_,,,,,Ke 1
, K 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.: ) j Page 2
Water service(no.linear ft.: ) Paget
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
MV
,.•P/ Backwater valve 12.51
' Clothes washer E 25.02 j
LA ti i' �" L dC)V q'I 10'>u Dishwasher 25.02
Drinking fountain I 25.02
Ejectors/sump 25.02
a t, x ,)'14,•._
"z €� � kl Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub j 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker j 12.51
77PFF n " a t o Interceptor/grease trap 25.02
i l tl r Medical gas(value:$ ) Paget
Business name:
Z v�.).�ut r ,tI�S 1ttiC
Primer 12.51
Contact name: J LiS vk.i ' tt1 i it,
Roofdrain(commercial) 12.51
Address: 7 3 c,,;',,,.... nk.) .t-C e bio C} Sink/basin/lavatory 25.02 /
City/State/ZIP: 13 q U (7 ),4., v r 9?06Solar units(potable water) 62.54
Phone:(y 755) 3 j , _ 6,7 Fax::( ) Tub/shower/shower pan 12.51 i
E mail La Xit'e �`1 c ) Urinal 1 25.02
Re.v�i. v 5: � C .r 11'(cr I L • C v✓"t
7 ;�, �wr . ���� Q,,4� � u, �,�
Water closet ( 25:02
� , C•` a ,._ C./ .T /MAVF f ' : Water heater 37.52
Business name: O EUC/ /y/Qit f,'
Water piping/DWV 1 56.29
Address: ✓`2>5 skAf 153rd,.(fE Other: ! 25.02
City/State/ZIP: / lJ, irc?/D/Yr 40,e cP7c/)7 , Subtotal
Phone:(503j ' /7-96aJ' 9 Fax:(503) p4b'-Q ,2// Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: /40 695 Plumbing Lic.no.: P Staten surchargeview (f 2%of permit fee)
Authorized signature: 133, 77✓`i �� 1� Z P8' - TOTAL PERMIT FEE
Print nameC .O 'y4:L/C,/ MO,4/e,tJ Date: /�9 Ara This permit application expires if a permitis not obtained within 180 days
/ after it has been accepted Ps complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:'flu ildding\PennitlrPLMt1-PecmnApp.doe 10/01/09 440-4616T(10/021COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12545 SW GLACIER LILY CIR, TIGARD, November 20, 2018 at
OR, 97223 9:11 :06 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00442
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor