Permit CITY OF TIGARD PLUMBING PERMIT
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a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00190
/ Date Issued: 07/11/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S109AB04300
Jurisdiction: Tigard
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Site address: 14464 SW 134TH DR
Project: Cone Subdivision: THREE MOUNTAINS ESTATES Lot: 36
Project Description: (1) water srvice 100 linear ft
Contractor: NW SUNDANCE SERVICES INC Owner: CONE, ROSE
10117 SE SUNNYSIDE RD STE F1201 14464 SW 134TH DR
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 332 -5720
HONE: 503 - 750 -7442
FAX: 503 -655 -3347
FEES
Quantity Description Date Amount
100 If Water Service 07/11/2012 $62.54
Specifics: 1 12% State Surcharge - 07/11/2012 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 07/11/2012 $9.96
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Akabl ` I A - ,. �� Permittee Signature: °V 1 1i T/Dli,
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.
07/11/2012 14:10 5036553347 NWSUN PAGE 02/02
Plumbin Permit A
Building Fixtures
IVED ,,),, 1),,il lr 11.1.,
City of Tigard
Received
te/B Da I (1 12i Pemtit No. :P�.1( _Iota- o p/qv
De
II _ a )3125 SW Hall Blvd., Tigard, C '''' II 1 2012 3 Phm Review
Phone: 503.718.2439 F 50.598.196O / Datels : Other Permit No.:
r i i : ,� r a Inspection Line: 503.639.4 O TI Rate Ready/sy: WM ® See rage 2 for
Internet: www.ti :� , or.; ; a Notified/Method: S • ,_, Iementai Information
E
❑ New construction ❑ Demolition
For swecial War/tuition use checklist,
Y AdditioWalteration/replacoxnent ❑ Other. Descriotiion I Qty. J Ea. I Total
CA: - EGORY'OF CONSTRVCTION . . New I- 2- family dwellings (includes 100 ft. for each utility connection)
❑ Commercial/industrial
SFR (1) bath 312.70
Al- 2- family dwelling SFR (2) bath
437.78
❑ Accessory building ❑ Multi-family SFR (3) bath 500.32
❑ Master builder ❑ Other. Each additional batb/ldtchen 25.02
• 108 . SITE INFORMATION AND . LOCATFON .., , . Fire sprinkler ( --- sq. ft.) Page 2
Job site address: i f{k /_h Su 1'Sy 4p R _ Site utilities:
f Catch basin or area drain 18.76
City /Statc/Z1P: . 4 i 1 l c vy
Dry
rywelt, leach line, or bench drain 18.76
Suite/bldg. /apt no.: Project name: Footing drain (no. linear ft__) Page 2
Cross street/directions to job site: Manufactured borne utilities 50.03
Manholes _ 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear R.: ^) Page 2
Storm sewer (no. linear ft.: ___) Page 2
Subdivision: _ Lot no.: Water service (no, linear fL: LOt Page 2 (/ Z .57
Tax map/parcel no.: nave or item: _
Back low preventer 31.27
DRSCRIPTION of WOIRK• ...
.. Backwater valve 12.51
4i.P&ACe WATtac. S®e1SG6 Clothes washer 25.02
Dishwasher 25,02
Drinking fountain 25.02 •
l'1tOPERTY . OWNiF>t f 0. • • - • . ` . TrmidN' Ejectors - • Ejectors/stunt) 25.02
Expansion tank 12.51
Name:
?pig coo ... Fixture /sewer cap _ 25.02
Address: 1 LfM (o•1 31rJ ) - ' i '4R Floor drain/fioor sink/hub 25.02
City/State /ZIP: T1 4 444 f a"... 4 7...4( Garbage disposal 25.02
Phone: (9,3) -31t,. 5720 Fax: ( ) Bose bib _ 25.02
*APPLICANT .: . . • • D CONTACT 'PERSON Ice maker 12.51
Business name : juw SvNp4kiee S �Qd J to f Medical (value: tr 2 ge 2
- Median gas (value: $ ) Page 2
Contact name: S ii.A.NAktd Primer 12.51
Address; /D II'? Se- Sfi,,,wy c n a nP g rC/Zh / Roof drain (commercial) 12.51
City /State/ZIP: ! Prietr Sink/basin/lavatory 25.02
Phone: ( 4 9 3) f g- b fli I Fax:: (,5) (5 77, 7. Solar units (potable water) 62.54
B -mad: ,µ,J ft/p p 4i41 r . . f, S ( Atipp,�� Urinal
Tub/shower/shower pan 25.02
CONTRACTOR:
. . - Water closet 25.02
Business name: Pilo SugoharCg- SF_ti 4I L.gS water heater 37.52
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Address: p I i SI_ _ r D 1. Waterpiping/DWV - 56.29
City/State/ZIP: C L i A. s i I e1015 Other 25.02
Subtotal
Phone: (VI) 999 ; ; ;I b $ Fax: ( to% Ce 33113
CCB Lic.: ` Plu mb ing Lic. no.: 'j?Q 9 O i> �1 '
r\ \ Plan review (25% of permit tee)
Authorized signature: �i �_ •- 4,\ State surcharge (12% of permit fee) Ci q i0
Print name: 5'1, o,J 1►-J[L[jpIL Date: •7 ]u l I¢ TOTAL PERMIT FEE S •'S(0
r: ttuildine .PermirolPLMU- PermitApp.00c 10101/09 440.4016r(10/02/cot.,w69) #( M