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Permit CITY OF TIGARD PLUMBING PERMIT '� COMMUNITY DEVELOPMENT P ermit #: PLM2011 00299 Date Issued: 09/30/2011 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel 2S1026CO3900 Jurisdiction: Tigard Site address: 12820 SW WATKINS AVE Project: Halstead Subdivision: Lot: Project Description: Bathroom remodel Contractor: BRUNER PLUMBING Owner: HALSTEAD, JOHN PO BOX 23985 12820 SW WATKINS AVE TIGARD, OR 97281 TIGARD, OR 97223 PHONE: 503 - 888 -6623 HONE: 503 - 484 -5105 FAX: 503 - 624 -2173 FEES Quantity Description Date Amount 1 ea Lavatories 09/30/2011 $25.02 Specifics: 1 ea Tub /Shower /Shower Pan 09/30/2011 $12 51 1 ea Water Closet 09/30/2011 $25.02 Type of Use: SF 1 12% State Surcharge - 09/30/2011 $8.70 Class of Work: ALT Plumbing Type of Const: 10 ea Minimum Fee Adjustment - 09/30/2011 $9.95 Plumbing 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 wor is suspended for more the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility N cn Cente hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules or dire questions to OUNC by Ilin 3.232 1987 or 1.800 332.2344 Issue By: J r 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. Plumbing Permit Application Building Fixtures , `• ; v t " = FORx QFF.I U SE ONI 1,. A, zr k �" �.' t -.as: i s t " s City Of Tigard Received QQ ( ,/'� J Permit No .�,&_ .,� Date /By y 0�0A Y� e. � /IiCC?'�'!i� 2 (� t , a 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review m ©rs Phone: 503 639 4171 Fax 503 598.1960 DateBy Other Perm No . Inspection Line' 503.639.4175 Date Read /B Jens ® See Page 2 for KI� Ready /By S . _ IGA Internet www.tigard - gov Notified/Method Supplemental Information ' = • — ° " WORK''' ORK ' u'r`: ": o • i } ,i %,r..4,,-: .' ._. •FEE *, SCHEDULE. . ' :.' a ;' . ❑ New construction ❑ Demolition For special information use c/,eck /i st. _ Description Qty Ea Total Addition/alteration/replacement ❑ Other New 1 - 2- family dwellings (includes 100 ft for each utility connection) - TION , ' :.:CATEGORY. OF 'CONSTRUCTION ' ' SFR (1) bath 312 70 el- and 2- family dwelling 111 Commercial /industrial SFR (2) bath 437 78 building SFR (3) bath 500 32 ❑ Accessory g ❑ Multi-family Each additional bath/kitchen 25 02 ❑ Master builder ❑ Other: —' Fire sprinkler ( sq ft) Page 2 , ' :JOB, SITE INFORMATION AND LOCATION I Site utilities: Job site address: 12% 2,0 5o la)O -r ll S , "' vLe . Catch basin or area dram 18 76 City /State /ZIP Drywell, leach line, or trench drain 18.76 � �� Footing drain (no, linear ft ) Page 2 Suite/bldg. /apt. no.: Project name: ljC ‘.1.epia Manufactured home utilities 50 03 Cross street/directions to job site: Manholes 18 76 5 GO (1 1t Ram dram connector 18 76 � Y' Sanitary sewer (no linear ft ) Page 2 Storm sewer (no linear (t.. ) Page 2 —1 Water service (no linear 6 ) Page 2 Subdivision Lot no Fixture or item: — Tax map /parcel no.: Backflow preventer 31 27 � • p .IM ��(((/// e-) " -DESCRIPTION OF WORK • - Backwater valve 12 51 ii'`'" Jr. � � ., Clothes washer 25 02 I Dishwasher 25 02 Drinking fountain 25 02 Ejectors /sump 25 02 EKPROPERTY OWNER ,• ' . • _ . ." .',❑ TENANT Expansion tank 12 51 Name Jj kn t -b1 -ff d Fixture /sewer cap 25 02 Address: 12 %?� 5l 1 I -P/ ; l 5 J�� _ Garbage rb drain/floor e disposal 25 02 sink/hub 25 02 w � T . Garbage disposa City /State /ZIP t' d be 9,� -3 Hose bib 25 02 tr i Phone ( ' g T ( 7 3 Fax: ( ) Ice maker 12 51 H ' 0 „APPLICANT ”; °i" . ' ' ,. 0 CONTACT PERSON , Interceptor /grease trap 25 02 Medical gas (value $ ) Page Business name 2 Primer 12 51 Contact name. Roof dram (commercial) 12.51 Address. Sink/basin/lavatory I 25 02 2 .02, City /State /ZIP Solar units (potable water) 62 54 Phone ( _ ) Fax. . ( ) Tub/shower/shower pan j 12 51 ii, q E -mail Urinal 25 02 CONTRACTOR ` _, Water closet ( 25 02 �cr 0 2. / Water heater 37 52 Business name. R ` v 4 e4/ / i -1. ( � / /4 Water plpmg/DW V 56 29 Address c) e ,6,.)-><- Z � 3 ( 8 S Other 25 02 City /State /`ZIP Subtotal 0 Z 5 I Phone. // �� Fax: ) ,C, / z _ - Minimum permit fee $72 50 51 • S c �) p �� Plan review (25% of permit fee) 1 CCB Lic : e7,3-13 7 Plumbing Lic no.. - f ` S` -� f /2 — State surcharge (12% of permit fee) T , 1 n d Authorized signature ✓�A�_ -- - --� TOTAL PERMIT FEE ., W Print na me / / v Date. This permit application expires if a permit is not obtained within 180 days L (/V `�� e/- I/ after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Sersice Board 1 \Bwldtng \Permns'PLMU- PernstApp doc 10/01/09 440- 4616T(10 /02/COMM'En)