Permit CITY OF TIGARD PLUMBING PERMIT
I N COMMUNITY DEVELOPMENT Permit #: PLM2011 -00087
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2011
Parcel: 25111 CC09700
Jurisdiction: Tigard
Site address: 15750 SW GREENS WAY
Project: Brown Subdivision: SUMMERFIELD NO. 2 Lot: 124
Project Description: Repipe & install new water heater.
Contractor: MP PLUMBING CO Owner: BROWN, HELEN
PO BOX 393 15750 SW GREENS WAY
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 03/22/2011 $56.29
Specifics: 1 ea Water Heater 03/22/2011 $37.52
1 12% State Surcharge - 03/22/2011 $11.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $105.07
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 N. cation Cen - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir- questions to OUN : fling 503.232.1987 or 1.800.332.2344.
Iss ed By: /r 1 , Permittee Sign t ure: z
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 11 )12 01 i I( 1 I ' (11\ I 1
City of Tigard 'iglu 1a af/�le Permit No.: 0 ._ if, a
_ q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
l
II Phone: 503.718.2439 Fax: 503.598.1960
Date/By: Other Permit No.:
I I Date Rea
In tion Line: 503.639.4175
I I L Page z for
", 1 spot. dylBy: Iwo See P
Internet: www.tigard or,gov Notified/Method: Su • • temenpl lnformratiun
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❑ New construction ❑ Demolition For special dt(orraallon use checklist.
Description I Qty. L Ea. J Total
t Addition/alteration/replacement ❑ Other: New I.. 2 - family dwellin (includes 100 ft. for each utility connection)
u ` SFR(1)bath 312.70
II.l- and 2- family dwelling ❑ Commercial/industrial SPR (2) bath E 437.78
SFR (3) bath 500.32
❑ Accessory building Multi family
Each additional Bette/ kitchen 25.02
Fire sprinkler (_ s9, ft.) ft.) Page 2
❑ Other
❑ Master builder
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Site utilities:
C-., 1 �� � a Catch basin or area drain 18.76
Job site address: l'" r
City/State/ZIP: 1 J ( - )1 9r- rl a t 1 Fo Footing drain leach !inc. i Or am .: drain 18
ty �� �! A r 1 � Lt`r 1 O i "i Footing d (no. linear ft.: ') Page
Suite/bldg./Vt. n0.: Project name: r . • - -a � i , Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18 76
Rain drain connector 18.76
Sanitary scwcr (no. linear ft.: _ Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no, linear ft.: _) Page 2
Subdivision: I Lot ono.: Fixture or Item:
Tax map/parcel no.: Baekflow preventer 31,27
C Backwater valve 12.51
I ,� Clothes Washer 25.02
■ • 6 R. 4 1 v . ,, . AJ \�` ,p , r I • Cbc, A l Dishwasher 25.02
Drinking !amain ■ 25.02
Ejectors/sump 25.02
Expansion tank 12.51
Name:
Fixture/sewer cap 25.02 Mill
-- ° Floor drain/floor sink/hub 25.02
Address:
Garbage disposal II 25.02 III
City/ State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
x +;; Interceptor /grease trap 25 02
Business name: Medical gas (value: S _) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/shower/shower pan 12.51
•0
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E -mail. e 111 II !1 ►.�1 V x
Urinal 25.02
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Business name: N(\� Z
,, 11(11,VJ 1 N C ` 1 V Water piping/DWV 56.29 S
Address: 0 Tiba CI Other: 25.02
City / State/ZIP: ( a . i S C) '1 /� 101 Subtotal gmtis
Minimum permit fee: 572.50
Phone: b j) (o - /J Fax:( "3) laS1'i - 1 \ lr
b0 Plumbing Lic. no.: .71 Plan review (25% of permit fee) CCB Lic.:
• State surcharge (12% of permit. fee)
Authorized signature:
r1 1 .
11A-m.A TOTAL PERMIT FEE 8 .Q 1
Print name yn� , �' �1 G _ Date: "� ' , l I This permit applleatlon expires if a G not obtained within 180 days
>) after It has been accepted d as complete.
*Fee methodology sir by Trl- County Building Industry Service Board.
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