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Permit CITY OF TIGARD PLUMBING PERMIT I - COMMUNITY DEVELOPMENT Permit# PLM2012 00270 Date Issued 09/18/2012 T WARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 1S134D606300 Jurisdiction Tigard Site address 11245 SW 112TH AVE Project Wynkoop Subdivision TORLAND ESTATES Lot 1 Project Description Install new water service Contractor THE PLUMBERS INC Owner WYNKOOP, DANIEL L & DEBRA K 90 NW 150TH AVE 11245 SW 112TH AVE BEAVERTON, OR 97006 TIGARD, OR 97223 PHONE 503-519-6644 PHONE 503 - 799 -7670 FAX 503 - 684 -1202 FEES Quantity Description Date Amount 50 If Water Service 09/18/2012 $62 54 Specifics: 1 12% State Surcharge - 09/18/2012 $8 70 Plumbing Type of Use SF 10 ea Minimum Fee Adjustment - 09/18/2012 $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 by calling 503 232 1 or 1 800 332 2344 Issued By ' �Ai i //� �'VCf(ii Permittee Signature 9AJ 4 I pp� [ 0� / 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 : 17.2012 01:31 ‘PM The Plumbers Inc 503 684 1202 PAGE. 1/ 2 Plumbing Permit ApDlic i ( E D Site Utilities 11)li (*I 1( 1: I '.l: u\l.\ City of Tigard S i r 1 7 2012 Received G DateB c (l�(l�- S r PenmtNo' e '� Ix — 000170 13125 SW Hall Blvd., Tigard, OR 97223 y Plan Review Phone 503 718 2439 fax q sTIGARD Date/By other ermit No - 1 r.; A r, I Inspection Line. 503.639. IL I3ING IN V ISf /NN Wits Bendy /By, ru } El Sec Page 2 for Internet' www tigard -or g NoidieNMethud, / f G Supplemental Information TYPE OF WORK FEE" SCHEDULE ❑ New construction ❑ Demolition For special Information use checklist Description I (AY I F.a. I total ® Addition /alteration/replacernent ❑ Other New I- 2-family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312 70 !: 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437 78 SIM (3) bath 500,32 ❑ Accessory building ❑ Multi-family Each additional bath/kitchen 25,02 ❑ Master builder ❑ Other. Fire sprinkler (_„__ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION bite utilities: Job site address. 11245 SW 112 Ave. Catch basin or area drain 18 76 City /State /'LIP: Tigard, OR 97223 I)rywell, leach line, or trench drain 18.76 Footing drain (no. linear ft. _) Page 2 Suite/bldg./apt. no I Pmjeet name Manufactured home utilities 50.03 Cross street/direcuons to,loh site Manholes 18 76 Rain dram connector 18.76 Sanitary scwcr (no linear ft : ) Page 2 -- — - — Storm sewer (no linear ft ) Page 2 Water service (no linear ft • AQ) I 1 Page 2 1 Subdivision. I Lot no.: Fixture or item: 1 ax map /parcel no. Bnckftllw preventer 31 27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25 02 Install new water service Dishwasher 25 02 Dnnking fountain 25 02 Fjectors/sump 25.02 0 PROPERTY OWNER , I © TENANT Expansion tank 12.51 Name. Dan Wynkoop Fixture/sewer cap 25.02 Address: 11245 SW 112 Ave. Floor drain/floor alnklhuh 25.02 Garbage disposal 25 02 City /State/ZIP. 'Tigard, OR 97223 hose bib 25.02 Phone. (503)799 -7670 Fax. ( ) Ice maker 12 51 0 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: 1'he Plumbers Inc. Medical gas (value, 4 � ) Page 2 Contact name: Judah Hamnes Primer 12.51 - Roof drain (commercial) 12,51 Address. 90 NW 150 Ave. Sink/basin/lavatory 25 02 City/State/7.1P: Beaverton, OR 97006 Solar units (potable water) 62.54 Phone. (503) 5196644 LFax:: (503) 684 -1202 Tub /shower /shower pan 12.51 l .ntad: c Irinal 25 02 CONTRACTOR Water closet 25.02 Water heater 37 52 Balinese name The Plumbers Inc. Water piping/DWV 5629 Address. 90 NW 150` Ave. Other. 25.02 City /Statc/ZIP. Beaverton, OR 97006 Subtotal Phone. (503) 519 -6644 Fax. (503) 684 -1202 Minimum permit fee' $72.50 '7? ,SO CCB Lie : 177214 Plumbing Lie no PB447 ... Plan review (25 %ui'permit ice) _ - State surcharge (12% of permit fee) ? r11 D Authorized signature. TOTAL PERMIT FEE %/>, Print name. Judah nes Date. 9/17/12 Tho permit appeal= expire If a permit is oat obtained a,rhtn 150 days _, _ after rt has been aaepted as complete. "Fee methodology eel by Tri•Coimty Building Industry Service Board 1 lulldmgerro s1PLMU•PeiamApp doe 10/01/09 940.4616T(10/02/COM/ EB)