Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00366
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2011
Parcel: 1 S 134ACO2610
Jurisdiction: Tigard
Site address: 11315 SW WILLOW WOOD CT
Project: MIETH Subdivision: ENGLEWOOD NO.3 Lot: 167
Project Description: Bathroom remodel.
Contractor: MODERN PLUMBING Owner: MIETH, BETTY M
11120 SW INDUSTRIAL WAY 11315 SW WILLOW WOOD CT
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 691 -6166 PHONE:
FAX: 503 - 691 -6771
FEES
Quantity Description Date Amount
2 ea Sink 12/07/2011 $50.04
Specifics: 1 ea Tub /Shower /Shower Pan 12/07/2011 $12.51
2 ea Water Closet 12/07/2011 $50.04
Type of Use: SF 1 12% State Surcharge - 12/07/2011 $13.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $126.10
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: 6 /
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.
Dec. 5. 2011 4:44PM Modern Plumbing No, 2745 P. 1 //y
Plumbing Permit Application., 'KED
Building Fixtures 1 FOR OFFICE USE °NI.V
City of Tigard cT-j 6 2011 � / �/D `! s,T Q '\
Permit �11` o
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l 13125 SW Ball Blvd., T OR X 0 / `�
1 G 6 °IIGARD p t y .
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Phone; 503.639.4171 Fax: 503.�9 8 OlherPermitNo.:
l'[c; Inspection Line: 503.639.411 1T11 v' DIV ISION DaleRe # ge 7i
y: - El See
Internet: www.tigard -or.go , Di Notified/Method: •• Supplemental Information
TYPE OF WORK FEE SCHEDULE
El New construction ❑ Demolition For special irtjonrtntlan use checklist
Description I Qty., I Ea. I T ota l
yr Addition/aheralion/replaccment ❑ Other: New 1- 2- family dwellings (includes 100 It, for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) balls 312.70
- and 2- family dwelling ❑ Commercial/industrial SFR. (2) bath 437.78
Accessory building El Multi-family SFR (3) bath 500,32
Each additional bath/kitchen 25.02
❑ Master builder 11 Other: Fire sprinkler ( sq.f1-) Page 2 t
JOB SITE INFORMATION AND LOCATION Slte utilities:
Job site address: � 1 31 S to c 1 � 0 tan Catch basin or area drain -
- 18.76
Jo �5 taod C .
CilylState/ZLP; " d Q C � , Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
SuilcJbldg. /apt. no.: Project name: 61. Q.-+t, Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
(
�� W"-G -5 ( U t. tom'+ e L_,.5% �� Rain drain connector 18.76
t Sanitary sewer (no. linear R.: _) Page 2
Storm sewer (no. linear ft.: ^) Page 2
Water service (no. linear ft.: ^) _ Page 2
Subdivision; I Lot no.: Fixture or Item:
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02 _
Drinking fountain 25,02
Ejectors/sump 25.02 ,
CI PROPERTY OWNER I 111 TENANT Expansion tank 12.51 '
Name:
- 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
❑ APPLICANT '❑ CONTACT PERSON ' interceptor /grease leap 25.02
Business name: Medical gas (value :T _) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory '2-. 25.02 S)(34
City /Stale/ZIP: Solar units (potable water) 62.54
Phone: ( ) I FOX:: ( ) Tub/shower/shower pan l 12.51 I ) s
E moil; Urinal • 25.02 y�
Water closet 2. 25.02 JST a`(
CONTRACTOR t Water heater 37.52
Business namem 0 eIe y- A ' V ) u Yrib;Y q - Water piping/DWV 56.29
Address: I ‘') 0 S to _Mel c l V S - A-1, (.1--)„ ^ , Other; 25.02
City /State/ZIP:' n AI �" t , ` � -'�v bb ` _. ' Subtotal (11,
Phone: (, t j t to Imo o Fax: 503 61 1 b I ll Minimum permit fee: $72.50
CCB Lie.: 13 1 1 Plumbing Lie. no.:3Lf ),ctl) Plan review (25 % of permit fee)
State surcharge (12% of permit fee) (351
Authorized signatur . 4, . 7 r I t'I
TOTAL PERMIT FEB / 4 !a
Print namey 2, (-y 1.[ f r 0s . Dale ; / -- A - - , I This permit application expires i[ a permit is not obtained within 1811 days
[[ ! after It has been accepted as complete.
"Fee methodology set by 'Fri- County Building Industry Service Board.
1:19uliding\PermiI OPLhMU -Pena App.dee i Qei 9 440_4616T(10/02/COM/W1B)