Permit CITY OF TIGARD PLUMBING PERMIT
: COMMUNITY DEVELOPMENT Permit #: PLM2012 -00259
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2012
Parcel: 2S110DD05600
Jurisdiction: Tigard
Site address: 10640 SW HIGHLAND DR
Project: Johnson Subdivision: SUMMERFIELD NO.4 Lot: 156
Project Description: (1) water service and interior water lines replacements
Contractor: ADVANCED PLUMBING LLC Owner: JOHNSON, ROBERT
PO BOX 593 10640 SW HIGHLAND DR
PORTLAND, OR 97207 -0598 TIGARD, OR 97224
PHONE: 503 - 649 -1744
HONE: 503 - 241 -4945
FAX: 360 -571 -4188
FEES
Quantity Description Date Amount
50 If Water Service 09/06/2012 $62.54
Specifics: 1 ea Water Piping /DWV 09/06/2012 $56.29
1 12% State Surcharge - 09/06/2012 $14.26
Type of Use: SF Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
•
Total $133.09
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:
D1.1 ,PP4 0 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.
Plumbing Permit Applica Y.: t p�llcn
Site Utilities v.., FOR OFFICE USE ONLY
i
City of Tigard C 0 6 2012 Receiv 4 4)1( yr Permit Nap(,JL(aoia- 'OC 7
9 13125 SW Hall Blvd., Tigard, OR 97 ply R eview
1 C • Phone: 503.718.2439 Fax: 503.598.1960 Other Permit Nn.:
T D Dainty:
Inspection Line_ 503.639.4175 -� Dion CITY 1 D ate R B tuna. ® See P e 2 for
Y
Internet: www.tigerd- or.gov NotificxUM
TIC Y Supplemental Information
TYPE OF FEE* SCHEDULE
❑ N construction ❑ Demolition For special irrjormatiorr use checklist.
Description I Qty. I Ea I Total
IIIWAddition/alteration/replaceinent ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility cormection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
Et< and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other.
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 0 & „ q. 0 S i G i PN) h r basin a m 18.76
�''['� I J Drywc ll, lieach or are line, or dra trench drain 18.76
City /State/ZIP: { RrI i 7 Footing drain (no. linear ft.: 1 Page 2
SuitebldgJapL no.: TI QJ� q 2- � / Project name: b e r ^ -I• t Manufactured home utilities 50.03 f ilo
Cross streel/directions to job site: v . Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft: _...tE) I Page 2 fP 2 , 5 Y'
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Badctow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
.�j Clothes washer 25.02
1Z1�LCP �_ ^j. I -1-er) & r � A I ( pp S Dishwasher 25.02
Li kI? "C OYT i 1 k e_ Drinking fountain 25.02
R€ T C c k , / i + r" £ r V I € so r Ejectors /sump 25.02
�L 7 ROPERTY OWNER ❑ TENANT Expansion tank 12.51
F
Name: 4j3 -4 6 r+ } ' 3pk iv s k,J l cap 25.02
Floor
J O S W J H i yh ti°t/J Ar Floor drain /floor sink/hub 25.02
Address: (s, f0 Garbage disposal 25.02
City/Stave. ZIP: I Q g ZZ /
Hose bib 25.02
Phone: (SO.? 4S yL 9 1794/ Fax: ( ) Ice maker 12.51
❑ APPLICANT [Z]- CSONTACT PERSON interceptor/grease trap 25.02
Business r ame: ----- Medical gas (value: Si ^ ) Page 2
Contact name: Q 'To k� Primer 12.51
(� x/ Or V Roof drain (commercial) 12.51
Address: / O (O f.1 S � y L 1 API) 1I) Dr Sink/basin/lavatory 25.02
City /State/ZIP: T -elp rd i Dz J 1 7 2 2 Solar units (potable water) 62.54
Phone: (:13) Z O) + 14 4 Fax: (3(41` S ! .. (8 fy Tub/shower /shower pan 12.51
� 25.02
E-mail: - -v���� dr i.4,41 /i.. l ail!�llili i.,.., ri al
CONTRACTOR ter closet 25.02
` f Water heater 37.52
Business name: , •_� ' V a a. Water piping/DWV , 56.29 S (0, Z.9
Address: ) c o b & 9 Other: 25.02
City/State/ZIP: ®�� L►rS N D i . Dia 9 77_07 Subtotal fie j �
(,� gel ✓
Phone. (Sod (4 j T i q� F ax (,36,0 s'7' f 4/
S;CB Lie.: lie s /_ Prianbing Lic. no.: f7Q I 7 Plan review (25% of permit fee)
r Q CSJ Minimum permit fee. $72.50
State surcharge (12% of permit fee) / 1.1. Zip
Authorized signature: a MCI: 1 ....• ; TOTAL PERMIT FEE /33.89
Date: This permit application expires rf a permit a not obtained within 180 days
Print name:
IMCp, 1 .��� Sept- 2 after it has been accepted as complete.
*Fee methodology set by TriCounty Building Industry Service Board.
T : doe 10/01/07 440- 4616T(I 0/Q7JCOM.1VEB)
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