Permit ® CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00357
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2012
Parcel: 2S 114BB 12200
Jurisdiction: Tigard
Site address: 16387 SW 104TH AVE
Project: Patton Subdivision: SWANSON'S GLEN NO.2 Lot: 63
Project Description: 50 linear ft. water service
Contractor: 3 MOUNTAINS PLUMBING Owner: PATTON, NANCY B
PO BOX 230051 16387 SW 104TH AVE
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503 - 670 -1342 PHONE:
FAX: 503 - 828 -0515
FEES
Quantity Description Date Amount
50 If Water Service 12/06/2012 $62.54
Specifics: 1 12% State Surcharge - 12/06/2012 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 12/06/2012 $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 OUNC by calling 503.232.1987 or 1.800.332.2344. , /
Issued By: _ r � , � (,( , 4 t Permittee Signature: D� I APPL ft4lQ L
'/J/14A-P-eil 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.
DEC-06-2012 16:22 From: To:5035981960 Page:1/2
Plumbing Permit A ' iicati ECEIVED
. 1 1
Building Fixtures DEC 0 6 2012 FOR OFFICE USE ONLY
1
City of Tigard TY OF ' --A Tionpa Received
P
el 13125 SW Hall 131vd.i Tigard, OR 972P Date/By: / • Pit No.:
1 p 4 4. 449 OI A - 0 0 36'7
1 1 = Phone: 503.639.4171: Fax: 503-5sORDING DIVISION Plan Review
Date/By Other Pennit No.:
- Inspection Line: 503639.4175
TI GAR oate Ready/0y.
Sec Pa
Internet: www.tigardfor.gov Notified/wood; I 2 ro
Supplemental Information
. .. tiv-pk:• .iio . . ,. .5,.• ,,,:..- • .. , ---... ::: 0g..-k • .':•:;:;:,' ..::.•••:...:?.::.
For special informfillon use checklist
CI New construction CI Demolition
Description I Qty. I Ea I Total
nplAddition/alterationlreplacement : III Other: New 1- 7-family dwellings (includes 100 ft. for each utility connection)
--..--- -
CATE601 OF CONSTRUCTION
-_, SFR (I) bath 312.70
()
J21- and 2-family dwelling 0 Commercial/industrial SFR 2 bath 437.78
SFR (3) bath 500.32
0 Accessory building 0 Multi-family
Each additional bathAitchen 25.02
0 Master builder CI Other: Fire sprinkler 1 ft.) Page 2
:
• .,..
r , -7- ,:.: - •, - JOB SITE INEbRIi4TION ND LO .: - Site utilities:
Job site address: /6 3 g 5 e.,./ /o It Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: (.r)," Footing drain (no. linear It: ) Page 2
Suite/bIdgJapt. no.: Pti:iject name. / Manufactured home utilities 50.03
Cross street/directions to job site: , 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.: IC)) Page 2 I 02 07
Subdivision: • I Lot no.: Fixture or item:
•
• Back preventer 31.27
Tax map/parcel no.: •
•:::.- '':': 6gsatiPTION. 00 .WORK Backwater valve 1251
••■•• • Clothes washer 25.02
Dishwasher 25.02
. , Drinking fountain 25.02
. Ejectors/sump 25.02
0:1 OWNE4:: . ),7.- ':.: 1: ..., ' i , TENANT . ; ....'".:::: Expansion tank 12,51
Fixture/sewer cap 25.02
Name: /1/ ?ki6r1
Floor drain/floor sink/hub 25.02
Address: _
• Garbage disposal 25.02
City/State/ZIP: •
•
Hose bib _ 25.02
_
_
Phone: ( ) Fax: ( ) Ice maker 12.51
-• . .: . 0 .APPLICANT I : •:k la CONTACT PERSON • Interceptor/grease trap 25.02
. ...
Business name: Medical gas (value: S ) 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
• .
. . .:. CONTRACTOR . -::. %.• .. .. .
... Water heater 37.52
Business name: 3 ni _7)44, 61_,... Water piping/OWV 56.29
Address: po /1*/ G 71 . ,c2c) 57 Other 25.02
-
City/State/ZIP: p44 q?,;,-/-.s," subtotal
-
iii
Phone: (.103) 62..0 / 'a eig. Fax: (9;) Minimum permit fee: 572.50 ) crV2r - 4:257,5" -
CCEI Lic.: /,('9'9'? 1 '
Plumbing Lie. no.: " 5>r Plan review (25% or permit Ice)
State surcharge (12% of permit fee) , WO
Authorized Signature: l ..4.1._.,.... TOTAL PERMIT FEE s- j.
.x iii This permit application expires if s permit is not obtained within ISO days
Print name: (,,2/ p ! i '1 (
--
I Date: id - - 7 . 2 ,
after it has been accepted as complete.
"Fee methodology act by Tri-County Building Industry Service Board.
)1130iloi4Per 41■10.PLMIJ -9r.4 mit App. doe 10/0 I /09 440.46 I 611 I Onn/CONVWER 1