Permit CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit #: PLM2011 -00133
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2011
Parcel: 25111 DB12000
Jurisdiction: Tigard
Site address: 15225 SW 94TH AVE
Project: Greenwood Subdivision: SUMMERFIELD NO.12 Lot: 647
Project Description: Fire damage repair.
Contractor: MP PLUMBING CO Owner: GREENWOOD, JO ANNE
PO BOX 393 15225 SW 94TH
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 655 -9161 PHONE:
FAX: 503 - 655 -1726
FEES
Quantity Description Date Amount
1 ea Hose Bib 04/27/2011 $25.02
Specifics: 2 ea Tub /Shower /Shower Pan 04/27/2011 $25.02
1 ea Water Heater 04/27/2011 $37.52
Type of Use: SF 1 12% State Surcharge - 04/27/2011 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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 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: Permittee Signature:
1r
i n
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.
,
Plumbint Permit Apptieatio! '•-. CEIVED _
Building Fixtures APR 26 ?nil t‘ % II( 1 i t i\1
City of Tigard TI Permit Nu.: 2/
I
M 13 125 SW Nall IItvd., Tig , • OF G` t AR D r� Pl att Rev iew
i1� , _ ��
I Phone: 503.718.2439 Fax: 4 1t -
itG DIVISION Damns an« Penult No. ,�'� i /i I .. t) :. L s
t Ml Inspection Line: 503.639.4175 Date Ready/By! lint.: f l See Pare 1 ter
- -- Internet: www.tigard- or.gov Natifie ethnd. J D Suppleseatel teforr.ean
T !PE OF WORK FEE" Scu1*DI,ILE :- .: .
0 New construction ❑ Demolition For special iafortnaflon use check:la
Dest _ 1 Total
Addi tion /al teretion ❑ Other: New 1.2- family dwellings (includes 100 ft_ for earn utility connection)
CATE OF CONSTII,OCTIOPI SPR (1) bath . 312.10
i 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
-. -- SFR (3) bath 500.32
❑ Accessory building ❑ Multi-family - ._....._...
Each additional bathlkitchen 25.02
CI Master builder l7 Other: -
..,.......... �...__._.._.. - - -- fire sprinkler ( sq. R.) Page 2
MD' SITE 11t1PORMATION ANJI LOCATION Site utilities.
•
Job site address: +2 17 ricla
'ih" Catch basin or area drain 18.76
-Flaw Drywell, leach line, or trench drain 18,76
City/State/ZiP:
I f � Footing drain (no. linear ft.. _) Page 2
Suite/bldg. /apt, no,: I Project name: 1 \.1\ , \ 0 t Manufactured home utilities 50.03
Cross steel/directions to job site: Manholes 18,76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _1 Page 2
Storm sewer (no, linear ft : ___) Page 2
Water sotvioe (no. linear H.: -. ) P age 2
Subdivision: Lot no.:
Fixture or Item:
Tax map/prime! no.: Backliow presenter 31.27
DESCRIP'T'ION Of WORK. Backwater valve 12.51
� h ' Clothes washer _ 25.02
lY� cj_ 1v Dishwasher 25.02
Drinking fountain 25.02
-
Ejectors/sump 25.02
0 PEtOPZRT'1' OWNER I 0 TENANT Expansion tan 12.51
Name: Fixture/sewer cap 25,02
Address:
Floor drain/Hoor shit/huh 25.02
Garbage disposal 25.02
City/State/ZIP: 11oae b 25 .02
Phone: ( ) Fax: ( ) Ice maker 12.51
0 APPLICANT Q CONTACT pEasJQM Intercepter /grease trap ' 25.02
Business Hama: - Medical gas (value: S _ ) Page 2
Contact name:
Primer 12.51
Roof drain (commercial) 1 2. 51
Address:
Sinktbmirtllavatory 25.02
City/State/ZIP: . Solar units (potable ureic!) 62.54
Phone: ( ) 1 Fax:: ( ) Tub/shower/shower pan Z_„ _ 12.51 075,02,
E-mail. R , r D Urinal 25,02
A.k au taw Water closet _ 25.02
■ MIRACTOR Water heater 37.52 Tc Z
Business nand: '\ L `-' � -' � G � Water piping/WV 54.29
Address: -7Q� 1� `?� - ' � Co l Other. 25.02
City/State/ZIP: , . . .&t / Oh qrlD OS-c-/-7.40 1S Subtotal , 6:7,...4.
Pbone: (S» l 1 Q C ! a , J Fax: (;1.21) Minimum permit fee: $72.50
CCD Lic.: } Plumbing Lic. no.: II Plan review (25%ofpennit fee)
! State surcharge (12% of permit fee) j
Authorized signature; t/ TOTAL PERMIT PEE L Q 7
Print name: 1_ )(_ n . a a Dabs: This permit ■ aen wino Il ■ n
pC pphca ' t>a permit I. not ebtaitaed 10/Mt too A■
after it act beer ■czsyad as cswpktc.
"Fee mdhodetogy tat by Tri- County Building Industry Savies Bond.
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