Permit CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit #: PLM2011 -00030
TIGARD 13125 SW Hat Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2011
Parcel: 2S 111 AD04900
Jurisdiction: Tigard
Site address: 8930 SW PINEBROOK ST
Project: GREEN Subdivision: PINEBROOK TERRACE Lot: 72
Project Description: Replacing hot water piping.
Contractor: MP PLUMBING CO Owner: GREEN, DONNA M
PO BOX 393 8930 SW PINEBROOK ST
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 655 -9161 PHONE.
FAX: 503 - 655 -1726
FEES
Quantity Description Date Amount
1 ea Water Piping /DWV 01/27/2011 $56.29
Specifics: 1 12% State Surcharge - 01/27/2011 $8.70
Plumbing
Type of Use SF 16 ea Minimum Fee Adjustment - 01/27/2011 $16.21
Plumbing
Class of Work: ALT
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 5003.2987 or.1.8 .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.
FROM MP Pl (WED) JAN 28 2011 11'. 30/ST.11'. 30/No.8308284726 P 1
Plumbing Permit Application n
Building Fixtures " i i 4 � ! 1!k 01 { It I I til' 0\1 1
City of Tigard JAN 2 6 2011 Received
www,ti rd-or- ov Dote/By; By: 1 11 i ermit Nc / /.. ,- a
111
_ % 1312 SW HMI Blvd 'Tigard, OR 9722 Plan Review
■ Phone: 503.634.4171 Fox: 509'.58 , +1960• , DateB Other Permit No,:
Insp Line: 503,639,4175 ✓t 1 � ' 1/r T � `
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DIVISION �,� NotiS had ,'� ' a Supplements' bdor�atb
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❑ New construction ❑ Demolition x° "Penisl information use chexkUtl.
D escription r Qty- I Ea. I Total
►41 Addition/alteration/replacement 0 Other: New 1- 2 - family dwell (includes 100 ft, for each utility connection)
'4 r a r t + �i r Y t + t 01 r .,, , r.,. f v i t i , ';;1 1!'4 $f SFR (1) bat 312.70
g10. �! r i 4i Chi ! .. , n3_ 7! �k K .a ( .
,.....,r.. , ... ,., r�''��, +ter...ri,�?�,���,��� -:pro .r „w� +;,�, .,
SFR (2) bath 437.78
® 1- and 2- family dwelling 0 Conunercial /industrial - ..., -
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bathAcitchcn 25.02
❑ Master builder 0 Fire sprinkler `_ sq. fl.) Page 2
�,r„ `+rl�4Jr /t�,rfa4 4 * ( i C1 ,,1 A dpi, 1 -'. el R )'ti � ?k�Yk S it�eetliitiea:
C'.
Job site address: 8930 SW PiNEBROOK ST Catoh basin or area drain I8.7b ^
•
City/State/ZIP: TIGARD, OR 97224 Ihywell, leach line, or trench drain 18.76 -_
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: Project name: #52528 GREG GREEN Mnnufeotured 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: __) Page 2
Water service (no. Linear ft.: _ 110 J Page 2 J 100.06
Subdivision: Lot n0.: Fliture or item: _
Tax map /parcel no,: - Ba ckflow pravantcr 31.27
r 1 " r k � e [ y r ') t X r t , i r + ?P pl, 'Af¢ , V sl, t A41■ 66t{t 1� "ati .c Backwater valve 12.51
,! V,iii/7 ,,r>. r rr it l V. A ,111 ?i 71" . 7 'i1' '; �,�C /.l�liey➢ f;, /n,4itj;.',N i )rl16i $ a11 .: -- .
Clothes washer 25.02
HOT SIDE REPIPE .
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
! ' Gila' til'Y { "-Py�'id r r - droe , • , ��ii�r.I yl v �.,nrtij£Mrtt:�r;� EX ion
a, <1r,N ®• ��,' ^ -0 ti "v1 S1i %r`ti ti +i n�r1 Pr t;:r!�`r�,ltLtrlt,�(F?�Ci vl'v tank 12.51
. ,
Name: GREG GREEN
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
' "'� r Ri wi '�'I "��y L r' ' r r° J , , � • rr M� r , ; �
; , Y .rin li, ""t;'!tP't147**, `?:,�i . av 'r` tkr ;�;g1W 1� j0 . u a z Interce /gr trap - 25.02
Business name: MP PLUMBING CO Medical g as (value. $ ) Page 2
- Primer 12.51
Contact name: CINDY CRIVELLONE - -
--- . _ Roof drain (commercial) 12.51
Address: PO BOX 393 sink/basin/lavatory 25.02
City /State/ZIP: CLACKAMAS, OR 97015 Solar units (potable water) 62.54
Phone: (503) 655 -9161 Fax: : (503) 655 -1726 Tub/shower /shower pan 12.11
E - mail: CINDYC*MPPLUMBING.COM Urinal 25.02
p ': �' i.t' , r r }1/0 lFr0. f5 1'r 4 �y nS15 t'�4� r r� k at' !r �llfl5tA' , i � t! 1A 1 v r i cy' Water closet
'''S'% 25.(12
3's i. , , �r'ft,ii : kit r1/; "!' 1 "r t" t +t 9t' ai r! ,ctrl ' ; i � lro
Wnler heater 37.52
Business name: MP PLUMBING CO Water piping/DWV I 56.29
Address: PO BOX 393 Other: 25.02
City /State/ZIP: CLACKAMAS, OR 97015 - Subtotal 100.06
Phone: (503) 655 -9161 Fax: (503) 655.1726 Minimum permit fee: $72.50 7,2 ,51.;
CCB Lie.: 5002 Plumbing Lie. no.: 3-17PB Plan review (25% of permit fcc)
State surcharge (12% of permit fee) ,....1.210T
e• 0
Authorized sigaatut TOTAL PERMIT FEE l 12.07' /.
Print name; CINDY CRiV]ELLOIVE Date ]126/11 ' permit application expires if a permit Is not obtehted within 180 days
after it has been accepted as complete.
-
• lee methodology set by •rri.Coilnty Building Induetry Service Board.
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