Permit �� lf'�`rt� "�rf; ■ �`�� �' PLUMBING PERMIT
k COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00338
TM ',l DATE ISSUED: 7/31/2007
11T 13125 SW Hall Blvd. Tigard OR 97223 503.639.4171
TM PARCEL: 2S103CD -02500
SITE ADDRESS: 13775 SW 116TH PL ZONING: R -4.5
SUBDIVISION: HOLLYTREE LOT: 007 JURISDICTION: TIG
PROJECT: VOYTKO
Project Description: Kitchen remodel. Other fix: ice maker.
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JENNIFER VOYTKO
13775 SW 116TH PL. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/31/2007 $72.50
[TAX] 8% State Surcha 7/31/2007 $5.80
Phone : 503 -NA Total $78.30
Contractor:
MP PLUMBING CO
P.O. BOX 393
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 655 -9161
FAX 503- 650 -7050
Reg #: LIC 5002
PLM 3 -17PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �,,td,ed__ /Ci yZZe4 Permittee Signature: )7-2 i 4,e✓&
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
From: 07/31/2007 08:24 11465 P.0021004
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Plumbing Permit Appl ii (. = I l►It t>I(I I(1 t _tiC c► I
City. of Tigard ><rd
Receive Date/13 07 y i Permit No.: � I/ >y 0 8
13125 SW Hall Blvd., Tigard, OR 97223 P IanR- w
Phone: 503.639.4171 Fax: 503.598.1960 C(' ' '� I Date/By: Other Permit No..
24 Hour Inspection Line: 503.639.4175 ?I L Date Read r u ^y> ® Sea Page 2 for
Internet: www.ci.tigard.or.us ���L r ( :'. :,', /
Notifi Supplemental Information
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❑ New construction ❑ Demolition - For special infonnauon use checklist
Descri , tion e4, . Ea. Total
la AdAddition/alteration/replacement p ❑ Other New 1- 2- family dwellings (includes 100 ft. for each utility connection)
r { }F ! ,
:: t 11 hi itt:z gfi.' :S`�' ?:� Y vit 141.. ,E t11'4 i T1 11.2 i : M1... ..Ln � l l' ';It to ,1 71 .4 �� (' SFR (1) bath 24920
14 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder ❑ Oth Each additional bath/kitchen 45.00
T t b��` 7
�S z5 ,, I1 2 ,y a r [T . ; aV s T xe a r, r + } I Fire sprinkler ( _ sq. ft.) Page 2
mr'.a ?7v ..111: .i o-i4 ,.'?t- lvi� zai:s: � d 41 - k!a. Y V lKJ ":1t � 7 t � - i..w�t � b ..1. J 1 _.�
_ ./ }_ti Site utilities
Job site address: J377s�.t/w /11 .. Catch basin or area drain 16.60
City/ State/ZIP: L 1lf 9722 Drywall, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: (4y` j /If/ / Footing drain (no. linear ft.: ) Page 2
/`� Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) ' Page 2
Storm sewer (no. linear ft:: ) Page 2
Subdivision: I Lot no.:
Water service (no. linear ft.: 1 Page 2
Fixture or item
Tax map /parcel no
Absorption valve
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Ir a..t ` li ltil= Vf.' 7 : : :, r :S g' A .?L� :r::.. i,: ...* � 2 . 9?.1 + y. >..' 11 >i; t i : ; t - .1 S i $ :1 Backflow reenter
p Page 2
i LB rLnn0/,/ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
T '' :' riV: sib , t Fl i` �,�' +kl ` " Ti i d u �' ` *' 11;..,11,7,-. 44 41-, CP ii! 141 , 1 �* - q -- . 4 , 4 4! Drinking fountain 16:60
idtu 1 .,:......L . t :Z.:cs,,.._..,..._.:,., x,. t,.. Ejeetors/sump 16.60
Name: � � Zt'V 74y �� Expansion tank 16.60
Address: �� It/1i17 Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60 , `
Phone: ( ) / Fax: ( ) Garbage disposal -j 16.60 A .
,�'ro p1 .1 t : t v .. , t r t i �, sue iFSi ii9 i iw s,c R ii `,4, , r V Iux, r�4'( Hose bib 16.60
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a.. Ice maker 16.60 , 4
Business name: MP PLUMBING CO.
Interceptor /grease trap 16.60
Contact name: TAMI Medical gas (value: $ ) Page 2
Address: PO BOX 393 Primer 16.60
City/State/ZIP: CLACKAMAS OR 97015 Roof drain (commercial) 16.60 4 (
Sink/basin/lavatory ' 16.60 lIlr
Phone: (503) 655 -9161 I Fax:: (503) 650 -7050 Tub/showerlshowerpon 16.60
E-mail: Urinal 16.60
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1 { Wa ter c 16.60
Business name: MP PLUMBING CO. Water heater 16.60
Address: PO BOX 393 Other:
i ll City/ State/ZIP: CLACKAMAS OR 97015 Subtotal ,
Minimum permit fee: $72.50 A q
Phone: (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: $36.25 I I.
CCB Lic.: 5002 Plumbing Lic. no.: 3 -17PB
Plan review (25% of permit fee)
lit
Authorized signature: 1,71/N4 'A State surcharge TOTAL E permit M T fee) / p
TOTAL PERMIT FEE
l Print name: TAMI GEORGE Date :7 30.47 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.
I: lBuildina \Permils\PLM- PcmritApp.dos 06/05 4404616T(1002/COM/WEB)