Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00027
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/07/2012
Parcel: 1S134CB02700
Jurisdiction: Tigard
Site address: 12180 SW SUMMER CREST DR
Project: Vranson Subdivision: SUMMER HILLS PARK Lot: 25
Project Description: Replace water service from meter to residential dwelling.
Contractor: PIPELINE PLUMBING Owner: VRANSON
333 S STATE ST, STE. V -108 12180 SW SUMMER CREST DR.
LAKE OSWEGO, OR 97034 TIGARD, OR 97223
PHONE: 503 - 624 -1906 PHONE:
FAX: 503 - 624 -1926
FEES
Quantity Description Date Amount
100 If Water Service 02/07/2012 $62.54
Specifics: 1 12% State Surcharge - 02/07/2012 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 02/07/2012 $9.96
Plumbing
Class of Work: OTR
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 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
r O /(/ i i 70 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.
Sep 07 00 04:59a p
--- ping Permit Application
Building Fixtures f \ MK OFFICE 1. SE O \L
City of .� ti Dakar. 02 7 /oZ It ,- Pe iN=;4 020 -fie /a
13125 SW Hall Blvd. Tigard, O . C1 ✓ A Plan Review
s : ' Phone 503.639 Floc 5035981 - V Q;i / DaodBY. A -
Inspection Line: 503.639.4175 w r ����G `` ,4\ - Date Re lly/Ey: ,, t0. Sen i' 2 Q=
'i I G:tI: D Internet ww.tigard -o g o o „� V WI' N o t i r d: J 1 (9 : SaC i ` alar esti'n •
TYPE OF WORK k.) \ic` :) FEE* SCIIEDC LE
D�niditi For special infom ndoausreka^^#:
❑ New construction E..1 rm Description i (41.). -rota:.
GS Addition/alteration/replacement ❑ Other: New l- 2- family dwellings (includes 100 ft :; r ; = -. -..=ms `s)
CATEGORY OF CONSTRUCTION SFR (1) bath -
'4 1- and 2- family dwelling ❑ Cormnercialfradustrial SFR (2) bath _ - _,
SFR (3) bath _
El Accessory building ❑Mufti-family Each additional balhAdtchea • i • :5 -:
❑ Master builder ❑ Other: Fire sprinkler (___ sq. ft.) • E- -
JOB SITE INFORMATION AND LOCATION Site utilities: '
Catch basin or sire drain - - -
Jo8 site address: Y)- C r sCeV ,} C r. : .
_ Drywell, leach line, OF trench drain -
City /State/ZIP: 1 1q() si t ({ q—) ?-.2-- Footing drams (nu• linear R.: _,,,) - -
Suite/bldg./apt no.: J Project name v I( ` �'\ T '(\ Manufactured home utilities • Cross street/directions to job site: Manholes - - _:
Rain dram come-nor _ - . c
Sanitary sewer (no. linear ft.: __) 3 Storm sewer (no. linear ft.: )
Water service (no. linear ft.: 1 i - -
Subdivision: i Lot no.: Fixture or item: -
Tax map /parcel no.: Below preventer • 3 .-
Backwater valve - - -
DESCRIPTION OF WORK f - -
• Clothes washer --
• N v 1V cm A_ Ejectors/sump -- - -- . e
i
❑ PROPERTY OWNER I 0 TENAiN'T Expansion tank 1 :.. • Future/sewer cap - - -- •
Name: -
Floor drain/floor sink/hub _- -
Address: Garbagr. disposal - -
City/StatefZ1P: Hose bib -= -
Phone: ( ) Faac ( ) Ice maker 12 .
0 APPLICANT . ❑ CONTACT PERSON Id�se �p ` 5.2
Busittess.narne: ` t l A 3i�\ lliti
i _ p 12.51 •
Contact name: MedieaJ gas (value $ ) PagF2 Roof drain (commercial) 12.51
Address: - Sink/basinliavaboiy Z -
City /StateJZlP: Solar units (potable water) 62.5. •
( 1251 •
Plt+oome: ) Fax : ( ) Tub/shower/shower pas
Urinal 25.02 2 i
)Email: •► i �:i . It • -. • G n ' .: :,. . 4
Water closet 2.5_002 3
CONTRACTO ; I - .r - CY' ter wa heats, 52 2
Business name: IP i ,0 i - C _ 11. V - a Water piping/DWV 56.29 I
Address: 3 t ' .
City/Stan/ZIP: t - Q� o G � Logo j (Q. cc) b .gi,..1 i _ Subtotal
e5 j 2-V4 1 t i Li J Fa'c (1 2-q ° i 2.. Minimum permit fee: $72-50
Plan review (25% of permitfee)
CCB Lie.: s j I P l rm l b' Lie. no : A i --
/Z / m �"� - State surcharge (12%ofpermit fix)
Authorized si
�J / i TOTAL PERMIT FEE 7. e2,0
Print name-
i� -�,..! �__.._. �1 �J.4 A�, � � � � notolrminedwcilun180 d
/ This permit appliesdoa expires Ira permitpermit's er y
A ‘: � . 6 - S 3 ( Da te: 2_ - after - k has 'beea accepted ascomplete.
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