Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00102
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2012
Parcel: 1 S133CD10400
Jurisdiction: Tigard
Site address: 11776 SW WILTON AVE
Project: Subdivision: COTSWALD MEADOWS NO.3 Lot: 136
Project Description: Move washer from house to garage
Contractor: TERRY MASSEY PLUMBING Owner: DUTKO, LAWRENCE & SANDRA JEAN
PO BOX 2407 11917 SW 34TH AVE
CLACKAMAS, OR 97015 PORTLAND, OR 97219
PHONE: 503 - 997 -0324 PHONE:
FAX: 503 - 655 -7065
FEES
Quantity Description Date Amount
1 ea Clothes Washer 05/02/2012 $25.02
Specifics: 1 12% State Surcharge - 05/02/2012 $8.70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment - 05/02/2012 $47.48
Plumbing
Class of Work: ALT
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 qu ions • UN . , Iling 503.232.1987 or 1.800.332.2344.
Issued By ZOtreakc Permittee Signet , A �
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.
s''
FROM :Terry Massey Plumbing FAX NO. :5036557065 May. 01 2012 04:28PM P2
Plumbing Permit AppliclatiiECEIVED
Building Fixtures 4)1 It i 1 ` 40 1
MAY -1 2012
City of Tigard Received
a ngoC 1f FORMrrxr PamirNo.: PLI4 ao 1 . - 00 /02_
_ 13125 550 Hal! 39 Tigard,
x: s nF TIGARD Plan R
il Phone: 503.718.24.24 39 Fax: 50 960 Other Permit No.:
• nsp
iection Line: 503.639.4175 Ii ILDING DIVISION a By: VII B See Page 2for
Internet: www.tigard Notified/Method: i e' Sa,. laments! information
'�.1: � o:��3a i• 4: ' •'r 7' i �;- �4'..�'.� 1� . � ra :. r1 y`, � � 1 0 l < 3•
•k`7 l : 53'• °3`+1 ^4 : is ?5lwjh.J,i°• i fn" ' x 4 W n .!�!T 'R- ".. , c�! t+. r c�::1�3:�t9f ✓er r :: :: a. 1.s.�. !R... .,.,r. vi. :1.i'.
1:0 New construction ❑Demolition
. For ;pedal irifom Rkhm use checklist
Description I Qty. I Ba- J _ Total
Addition/alteration/replacement ❑ Other. New t- 2- family dwellings (includes 10011 for each utility connection)
. C. K :4 :.. . .
. b . ,-. A..w. s . F, t;, +'P. '`''4.: ` .< SFR (Q bath 312.70
,.7y��F �� �):�:tt \ 'dny.{£y.. ��� . ..'•!..,.; . ADZ \s C , , ' n '0• , �' 4.mreiGk��i��i:�ia
" .Kh ��::��Y. �.N .:- .MY. I �-�i'�. �: . � . 1 1 . ry.l�,. ` ' .. -
® I - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
El Accessory building ❑ Multi - family SFR (3) brute 500.32
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler C- sq. R) Page 2
r., i�r ,. , R .,�. .. .. , s, c. t . i
r- i : �.�.xS a y a • • q tr � 1RMer , . '' Site utWths:
Job site address: 1177GSW Wilton
Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR Drywell, Mach line, Or trench drain 18.76
Footing drain (no. linear R.: Page 2
Suite/bldgJapt. no.: I Project name: Manuthctured home utilities _ 50.03
'Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear It: _,_) Page 2
Storm sewer (no. linear R.: _J Page 2
Water savior (no. linear ft.: .,,,, j Page 2
Subdivision: I Lot no.: Fixture or Rem:
Tax map /parcel no.: BadtOow preventer 31_27
•:: .i0 4.t § 4;' i:0 044tyc b,, • Bat3tvvarervalve 12.51
ClaUaes washy 1 25.02 25.02
move washer from house to garage Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
„ ' y �" C . ' IN . . . t .: i�'. '? :i ; . ,i`.' . :; '.^L "• i y 3- a r •s'=t+ {� ,�y ha zon tank 12.51 -
Name: Fixtur /sewer cap 25.02
- Floor drain/floor sink/hub • 25.02 •
Address: ' '
Garbage disposal 25.02
City/State/LIP: Hose bib 25.02
Phone: ( ) Fax: ( ) la makes 12.51
r�'�,� f: +• .��;::- :�':,.:: �u .4 Ore;. , -w
�u�t • ep1! ;. - l , 4 , ' : -., •4'. 44 ' .:4- W, :, ''; .' ; �" � ' : , ''''' .; . Imes cP rigrcasc trap 25.02
Business pane: Medical gas (value; $ w _ ) Page 2
Primer 1231
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
-
City /State/Z1P: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) TuWshowts /shown per 12.51
E -mail: Urinal 25.02
-! ti-tr. n ;r ,g e Yr , r� n �cLE weer closet 25.02
tr . n: 3 } ,4 {iic .ti N 4Z *: . ° °.,' t ,' '!.' ; r er 5 , IN
,�...�$k�,,; : +�_,: r+t�'»rr. M. -e;� , r. , . ,. c2:i3' • 'ea,'ti water heater 37.52
Business name: Terry Massey Plumbing r
water piping/DWV 56.29
Address: PO Box 2407 Other 25.02
City/ State /Z1P: Clackamas, OR 97015 Subtotal 25.02
Phone: (503) 997-0324 Fax: (503) 656 -1065 / Minimum permit fa: $7230 72.50
1 CCB Lic.: 151756 ✓ Plumbing Lie. no.: 3.480PB ✓ Plan review (25% per f sir
,,�� Stale surcharge (1246 of permit fee) J,M S-1
v
Authorized signature: -.../3.1 TOTAL PERMIT FEE 40.62
This walk application aspires if a permit is not obt within 180
Print name: Terry Massey DatC $/1/jZ I n alter it has been accepted as complete days �'!
'Pee Iwdoloa set by Tri- Cormty Building Wintry Serves Board 'fa
FROM :Terry Massey Plumbing FAX NO. :5036557065 May.01 2012 04:27PM 1
TERRY MASSEY PLUMBING
P.O. BOX 2407
CLACKAMAS, OR 97015
CCB# 151756
503- 997 -0324 OFFICE
503 -655 -7065 FAX
mtjmasseyC3a comcast.net
FAX TRANSMISSION
To: — Date:
/,
No. Of Pag cL cover sheet)
.3
Fax:
563 - 59r
Attin: 1
Re. . 'pi/01147
Remarks:
a...m. � P R/ V ^ r
•
Re:
Remarks:
•
Cc:
Fro/
If yo ve not received all pages please give our office a call.