Permit CITY OF TIGARD PLUMBING PERMIT
I I COMM UNITY DEVELOPMENT Perm #: PLM2012 -00131
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012
Parcel: 2S114BA02600
Jurisdiction: Tigard
Site address: 9750 SW SERENA WAY
Project: Cohoon Subdivision: PICK'S LANDING NO.2 Lot: 113
Project Description: (3) lavatories, (1)shower, (1)water closet
Contractor: M B PLUMBING Owner: COHOON, ROXANE
7112 NE 65TH PLACE 9750 SW SERENA WAY
VANCOUVER, WA 98661 TIGARD, OR 97224
PHONE: 360 - 608 -9521 PHONE:
FAX: 360 - 696 -3330
FEES
Quantity Description Date Amount
3 ea Lavatories 05/22/2012 $75.06
Specifics: 1 ea Tub /Shower /Shower Pan 05/22/2012 $12.51
1 ea Water Closet 05/22/2012 $25.02
Type of Use: SF 1 12% State Surcharge - 05/22/2012 $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: Dki , 1 l 1 PPb /f A-nOAi
_./41p../._____ 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.
05/22/2012 08:54 5032318805 SELLWOOD CO. #5210 P.002 /002 S.
Pl mbin2 Permit Application o ff '
•
/Auilding Fixtures ° ! F„0,, t.)1 1 1C i S1 (;'1.\
C' and
of n"ed Permit C� > I? s� gitao(. 00 131
�- 13125 SW Hall Blvd., Tigard, OR 97 Him Review
' • • Phone: 503.7182439 Fax: 503 962 2 2012 Date/By: Other Permit No.:
T 1 C :\ :t) n Line: 5033,639.4175 Date Ready/By: ® See Page t2 Interne Y www. ti gaedor. gov N S� ppkmes tsl far mews
SRC: - r _� cow _ l.! 9a1.L „:. ! r G P Y
- ...'!�: :'?€Z . ,Z' ^ I '`• • J - 1; A • 0� • SI O - wr y µ ' i'D'ti'? '�• ..
4 �' r . W'�T��',`.._'�. r: ,. � - :J (�11�4t - .. ..... : ...........,_...... .,...:, -..
❑ New construction • ❑ Demolition For special information use checklist
Description I Qty. I Es. I Total
'Addition/alterarion/replacement ❑ Other New 1- 2-family dwellings ngs (includes 100 ft. for each utility connection;
'::; :. •- ... ; ' " °' : .° ".: SFR (I) bath 312.70 •
r and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/ldtchen 25.02
❑ Master builder . • ❑ Other: Fire sprinkler (-_ sq. ft.) Page 2
...TM' ' SIrB' iNfoliblAtiON. A tOCATIOI' . Site utilities: •
Job site address ' R 15c, 5(A) 5e NAt WA-7 Catch basin or area drain 18.76
brywell, leach line, or trench drain 18.76
City/Stat : 1 "L�, '�' .o 47 0� g
Footing drain (no. linear R: ) Page 2
Suite/bldg./apt. no.: Project name: Manufactured 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: _) Page 2
Water service (no. linear•$.: _ Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: • Backflow preventer 31.27
. ... I ,,. il'_ r o oft' WORK .
Baekwatcr valve 12.51
AA Clothes washer 25.02
Il� 2 W � �' �!� l/1 , / C `( /� `Z �"� Dishwasher 25.02
/ Drinking fountain 25.02
Ejectors/sump 25.02
C pRO sierl . ow•lER I . .
. CI p Expansion tank 12.51
Name: n ) ( 4 ,) E . co goc2A) 1 xture/sewer cap 25.02
• Address: , Floor drain/floor sinWhub 25.02
�� � � a 1 Garbage disposal 25.02
City/Stale/DP: `"l 0 g. y 70643 q Hose bib 25.02
Phone: ( ) . . Fax: ( ) Ice maker 12.51
"Q' A'I>yPl:7<E"Ailtl'I' • ' . .. ..o. CoP1>E'AC'r p interceptor/grease trap 25.02
Business name: C� €. 1 W O� t Medical pis (value: $ ) Page 2
•
Gv �c 3� 72,u C.41 C v► Primer 12.51
Contact name: k1 v.e k k 1t7 Roof drain (commercial) 12.51
Address: 114 SF ti p :J) . Sink/basin/lavatory � 25.02 I15#C1
City /State/ZIP: re rz. „4-1 a pi a ]] 012_ q7 c p� Solar units (potable water) 62.54
Phone: ( 54,12) it S, ~ i a' T Fax:: ( ) - �, 5 Tub /shower/shower pan 1 12.51 I z , s
E -mail: , L-L W OODCC C C HAAL •C0 M Urinal - 25.02
. Water closet 1 25.02 a9 ?f -D
• C'RACFOR
A Water heater 37.52
t Business name: • ? p L O Tj /� i M (� L.. L � V Water piping/DW 56.29
Address: ' 2 N E 6, 5+L PI . Other: 25.02
City /Statc/Ll (, ,C V ic•Z \./V 8 9) 6 G' ( Subtotal I i 2 , Y
Phone: ('1 I) 5 - (b ).-f Fax: ( ) Minimum permit fee: $72.50
Plata review (25% of permit fbe)
CCB Lie.: I'CI Z 5 c 4 I of Plumbing Lic. no.: S"1 - 5 ? h •
permit State surcharge (12% of fcc) . I S,. G
Authorized s• cure: j 'ii ' y ,
TOTAL PERMIT FEF
Print name: V(`7)� all Date: j. /2... 1 n il p ermit applicadoa aspires it permit is not obtained within 180 days
after it has been accepted as complete.
- • "Fee mahodology set by Tri-County Building Industry Service Board.
t: lStuld ieePerodis\PLMU•PenotApp.dee 10101/09 440 4616v(I0/02.ICQMMAVD)