Permit CITY OF TIGARD PLUMBING PERMIT
1 14 -
• - COMMUNITY DEVELOPMENT Permit #: PLM2012 -00334
13125 SW Hall Bl vd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2012
I1GAF Parcel: 2S112BA00800
Jurisdiction: Tigard
Site address: 14460 SW 80TH PL
Project: Hays Subdivision: WAVERLY MEADOWS Lot: 44
Project Description: Repair 50' of water service.
Contractor: 3 MOUNTAINS PLUMBING Owner: HAYS, SHELLEY
PO BOX 230051 14460 SW 80TH PL
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503 - 682 -9466
HONE: 503 - 670 -1342
FAX: 503 - 828 -0515
FEES
Quantity Description • Date Amount •
50 If Water Service 11/19/2012 $62.54
Specifics: 1 . 12% State Surcharge - 11/19/2012 $8.70
Plumbing
• Type of Use SF 10 ea Minimum Fee Adjustment - 11/19/2012 $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: Permittee Signature: e , v m o, L , e4E-7
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 Applicatio
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Building Fixtures
City of Tigard Received
• 13125 SW Hall Blvd., Tigard, OR 97223 Dale/By: /Of 4°2'„ Permit No.i L /1020/a - 0033 r
C Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.:
Date/By:
Inspection Line: 503.639.4175
T I G A K D Ready/By:
I Hi See Page 2 for
Internet: www.ti and - or. ov Note e/ � / l
g 8 Notified/Method: Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
.Addition/alteratiorJreplacement ❑ Other: New l- 2- family dwellings (includes 100 ft. for each utility connection)
. ' "` '. c :'' ' '"'°` CATEG OF« CO NSTR . UCTION 6 " s vii, ? � _ ' 'g= SFR (1) bath 312.70
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j 2rI- and 2- family dwelling ❑ CommerciaUindustrial 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' IN ,' .,. LOCATION '' � • � `' :� � i ORMATION • AND •LOTI
CAO' `L ` ' ` =' '°
- ..= + : :•^ .... . r................... ... . ' - ". . . , f,. x_f.`]: �_,s� Site utilities:
Job site address: / 7 y7 o 5“) go �'' P/ , Catch basin or area drain 18.76
City / State/ZIP: 7' / Dj y Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ____) Page 2
Suite/bldgJapt. 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 R.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: 5'0) SO Page 2 C. L 4
Subdivision: Lot no.: Fixture or Item:
Tax map /parcel no.: Backflow preventer 31.27
,r:`. ... s �s ;�_l: ; c:D ' 1+ i - ; - ;.�,,,p ie;z , " - ;n. {r,,° :: t :- rib Backwater valve 12.51
:.ti °'' ; : AvS.S , O....- WOR1C �: ;u .; .cr. f ; s a
. , .:.5 :,. ,. ... _. ..._ . .. •'F::%M. .'.,y� j��'i .fir „'i
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
d;° ,w - °c: tix. :..? " '�N Expansion tank 12.51
�❑ PROPERTX1O.VI!NER {� _�' s'•. . , .t : ; m � }TENANT ; K.-� :�����; p
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Name: Shelly Hays Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: same Garbage disposal 25.02
City /State/ZIP: _ Hose bib 25.02
Phone: ( 503 ) 682 - 9466 Fax: ( ) Ice maker 12.51
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`. k z • ?;APPLICANT, ? ''� , r
' : -,/ • . ;;. . '. ® .. ∎ :ACf :... • _ 4 ' .. 5 Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
- Water closet 25.02
: S. • ;: _ <, CONTRiCCfOR;' -T:.: -
Water heater 37.52
• • Business name: 3 Mevn -a.✓15 /O /drri,4 J Water piping/DWV 56.29
Address: ,n0 e0X 43 005`/ Other: 25.02
99
City / State/ZIP: �pr„ � O/P �o( &/ Subtotal G `,,,
Minimum permit fee: $72.50
Phone: (503) ( y?-0 /3 41 l Fax: ( )
Plan review (25% of permit fee)
CCB Lic.: /6 f y4f y � 7 //y Plumbing Lic. no.:
State surcharge (12% of permit fee) br. .9v
Authorized signature: 17 • TOTAL PERMIT FEE �/,
/ r This permit application expires if a permit is not obtained within 180 days
Print name: (,✓; /r2 rhr , 4 Date: / - �f / after it has been accepted as complete.
•Fee methodology set by Tri -County Building Industry Service Board.
I: \ BuildingTermiu \PLMU- PermitApp.doc 10/01/09 440- 4616T(10/02/COM/WEB)