Permit CITY OF TIGARD PLUMBING PERMIT
3 COMMUNITY DEVELOPMENT Permit#: PLM2020-00096
Date Issued: 03/04/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111 DA01000
Jurisdiction: Tigard
Site address: 8620 SW BRAEBURN LN
Project: Gibson Subdivision: APPLEWOOD PARK Lot: 6
Project Description: Full house water repipe.
Contractor: DAVIS PLUMBING Owner: GIBSON, PATRICK MORGAN
16008 SE SOUTHVIEW AVE 8620 SW BRAEBURN LN
MILWAUKIE, OR 97267 TIGARD, OR 97224
PHONE: 503-307-1920 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Piping/DVVV 03/04/2020 $56.29
Specifics: 1 12%State Surcharge- 03/04/2020 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment- 03/04/2020 $16.21
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 32.1987 or 1. 00.332.2344.
—
Issued By: �e� Permittee Signature: Sr-r
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
City of Tigard Dear G/a)-0 "1 ,&?0442 -Czb9G
13125 SW Hall Blvd_Tigard,OR 97223 �aw Rev
g Phone: 503.718.2439 Fax: 503598.1960 Piarnes Once Perot No.:
»p ��y
. +. eat I+ Inspection 503.639A175 -ptRedytey, wee ! /'.foe POW 3far
Infarct: www.tigrd-or.gov Noti/ed/MdlQd: l ga,plaeemal Glvnn+W.
MR OF WORK tP'
❑New construction ❑Demolition For weld hyornadoe w eieeklrx
-t Description I DD. i FL f Tracts
Additioe/alteradon/replacement 0 Other: New I.24adly dwellings(includes 100 a.for each ' connection)
CA ORY:or Coostancr4ON.:_- .. ..0 i SFR(I)bah 31270
®I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
-
❑Accessory building 0 Multi-family SFR(3)bath 50032
Each additional b hikitcba 2502
❑Master builder 0 Fire sprinkler( ,sq.R) Page 2
JOR INFORMATION AND LOCATION • She atiptls:
lob site address:86f,dp j W n if\ - Catch basin ar area drain 18.76
City/Statell_fP:'�Q��dDryly/ell.leach lice ar wench draint8.76
IO Footing drain(no.lines ft.:_ ) Page 2
Stritdbldglapt no.: I Project name: Manufactured home utilities 50.03
Goat arreet/diroctiom to job site. Manboles 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear R: ) Page 2
Storm sewer(no.linear ft: ) Page 2
Water service(not tines R:_J Page 2
Subdivision: I Lot no.: nature or Item:
Tax map/parcel no.: Backflow 1reventer 31.27
fig lopai: .-a S.'-''' Backwater valve 1231
i c ' pc Ohl:wClothes wa>ha 25.02
ishwarfrr 2502
Drinking fountain 25.02
E]acues/sump 25.02
0 PtOsion*d W} I 0-moan Expansiut tanks 1251
Room/sewerNameRoom/sewercap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Huse bib 25,Q2
Phone:( ) Fax:( ) Ice maker 1251
1
a'" s . '' 0 a rtnccr wawa imaadgra ptose trap 25.02
n l�
Business name: St• 1?��` `NMedia)gat(value:$_) Page t
r l�
Primer 1251
Contact name: ! ``tom ti) isiA3 Roof drain(commercial) 12S1
Address: ' 04 M n Sink/busavuory 25.02
City/StatdIIP: ; -, `1 C W l Solar units(potable water) 6234 _
Phone:(5033l�-l l V`) Fax::( ) Tub/darWa/showerpao 1251
E-mail:S O UMC 30na Teri %la closet 25.02
_.. Water haw3752
Business name: %ter pipiog/DWV '1 56.29 56 r roll
Address: Other. 25.02
Goy/StatelLlP: C 4 yi., ,ci,
Sebtelal cro,aCI
Phone:( ) Fax'( ) Minimum permit gee: $7250
OCB Lic.:l&S5 Plumbing lic.no.:.. •-55127rP% Plan review (25%of permit fee)
,�(� State surcharge(12%of permit fee) _C}, 70
Authorized signature: VrQ. 1\ ibTAL PERMIT FEE ]YS11
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