Permit (163) 111 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00137
T t ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/04/2019
Parcel: 1 S 136DA02400
Jurisdiction: Tigard
Site address: 11123 SW 68TH PKWY
Project: RPC Tigard Storage Subdivision: WAY LEE Lot: 1
Project Description: 75 ft.of water service and(2)backflow preventers.
Contractor: CH KRUSE PLUMBING Owner: RPC TIGARD 68 LLC
1527 SE 104TH CT 2101 CEDAR SPRINGS RD STE 1600
VANCOUVER,WA 98664 DALLAS,TX 75201
PHONE: 360-573-4337 PHONE:
FAX: 360-573-5303
FEES
Quantity Description Date Amount
75 If Water Service 04/04/2019 $62.54
Specifics: 2 ea Backflow Preventer 04/04/2019 $62.54
1 12%State Surcharge- 04/04/2019 $15.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $140.09
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: -•rmittee Signature: A,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. G,,,
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 FOR OFFICE t SE o Lti
Received
Ci of Tigard , -� Permit No.:/94/1.4)/
3
01 13125 SW HallgBlvd.,Tigard,OR 972 a j�,' Date/By: L1�1`l (/"t q _�/ 7
Plan Review
111 III Phone: 503.718.2439 Fax: 503. 1Other Permit No.f� a a� F
Date/By: 1L+tP.W)7`Gt . iJ
7 1 c,A lz 17 Inspection Line: 503.639.4175 f��9 Date Ready/By:
Juris: ® See Page 2 for
Internet: www.tigard-or.gov ,•; V'TJ Notified/Method: 0 - Supplemental Information
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Vii/,„,,z.,,„".: P " _ //''f9�i ,. , q /// y4y::kja////iiA: ..1' �40:n/y9 Y
>rn i.; °Y. , � t tl '. �t' , « =., 'For s I ectal information use ch klist �
// New construction ❑D i
Descri,tion • . Ea. Total
❑Addition/alteration/replacement ❑`a ther: New 1-2-family dwellings(includes 100 ft.for each utility connection)
- , - q' i # �`' ,%4� ,, SFR(1)bath 312.70
El 1-and 2-family dwelling F'_: Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
IDAccessory building El Multi-family
Each additional bath/kitchen 25.02
El Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
.� '�` .ij/r,'l'i�a-: ce ',-, i" , s Lit ••:%-,,,,. 1 �i<,,,y �,_ /:-,.. r Site utilities:
Job site address:11123 SW 68"'Parkway Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 �1
gee-'fa Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name4Tigard Storage Manufactured home utilities 50.03
Cross street/directions to job site: 1 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.:75) 1 Page 2 62.54
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 2 31.27 62.54
r J 5, Backwater valve 12.51
Clothes washer 25.02
install 75'of 1"water service and two 1"double checks
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
t.E e s Expansion tank 12.51
,
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
4 - ; '¢ ,44 ., ,, I =_ Interceptor/grease trap 25.02
Business name:CH Kruse Plumbing Inc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Carl H.Kruse
Roof drain(commercial) 12.51
Address:5802 NE 88tH Street Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98665 Solar units(potable water) 62.54
Phone:(360)518-2575 Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:carlkruse@comcast.net
fa Rig Water closet 25.02
Iffif` �' " . -' ' '� Y Water heater 37.52
Business name:CH Kruse Plumbing Inc Water piping/DWV 56.29
Address:5802 NE 88th Street Other: 25.02
City/State/ZIP:Vancouver,WA 9866.5 Subtotal 125.08
Phone:(360)573-4337 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:111654 PlumbingLic.no.:37-296PB Plan review (25%of permit fee)
�+/t j State surcharge(12%ofpermit fee) 15.01
Authorized signature: TOTAL PERMIT FEE 140.09
Print name:Carl H.Kruse 7,;(11"/ . 44_.q- Date:04/03/2019 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.
440-4616TQ0/02/COM/WEB)
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09