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Permit q CITY OF TIGARD PLUMBING PERMIT l a :. C OMMUNITY DEVELOPMENT Permit #: PL013 00054 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2013 Parcel: 25101 DB00613 Jurisdiction: Tigard Site address: 13235 SW 76TH AVE Project: Hollis Subdivision: ROLLING HILLS Lot: 18 Project Description: (1) water service 65 linear ft Contractor: M5 PLUMBING SERVICES LLC Owner: HOLLIS, MARK & TONNA PO BOX 821143 13235 SW 76TH AVE VANCOUVER, WA 98682 TIGARD, OR 97223 P PHONE: 503 - 372 -9531 PHONE: 360- 624 -8376 FAX: FEES Quantity Description Date Amount 65 If Water Service 02/14/2013 $62.54 . Specifics: 1 12% State Surcharge - 02/14/2013 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment - 02/14/2013 $9.96 Plumbing Class of Work: OTR Type of Const: ._ Occupancy Grp: Stories: s. Total $81.20 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: [L . I �_ ,1 Permittee Signature: Ok i n D n� Call 503.639.4175 by 7:00 a.m. for the next available inspection date. f +` /' U'\ This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 02/13/2613 11:50 3608285384 M5 PLUMBING LLC PAGE 01/01 lumbing Perm Ap plieatioi? CEWED . Site Utilities • FEB 13 2013 R eceived City of Tigard a(, 4 r 3 c f Permit No.: PIA d)1 3- °cos ) . 13125 SW Hall Blvd., Tigard, OR 972/1,,,,,, • OF , I � . Phone; 503.718.2439 Fax: 503.598. l l OF TIGARD Plan Review Other Permit No.: Inspection Line: 503.639.4175 VISION >aa • 7- ' �, " BUILDING • D Dare lte adyl$ y ; r r pJ See Page eatal 2 for formation Internet: www,tigard- or.gov ` N orified/nrta hon: • • (I Su 4P In ,; ,. ' ::.1'.::.: ., .: . :•:....,..: OF E,,. ? S ❑ New construction ❑ Demolition Far special information use checklist Description I Qty. I Ea. I Total ® Addition/alteration/replacement ❑ Other. • .. New 1- 2- family dwellings (includes 100 ft. for each utility connection) ;CA kEGQR1': OF CONST[t>t7CTI0tY SFR (1) bath 312.70 ® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 • building SFR (3) bath 500.32 ❑ Accessory g ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑Other Fire sprinkler sq. R) Page 2 ;.:. ,. ,, .. ,, .. , ,,' JOB SITE RMt1TION: AND LOCATION Site utilities: - Job site address: 13235 SW 76 Ave Catch basin or area drain 18.76 Drywell, leech line, or trench drain 18.76 City /State/ZIP: Tigard, OR 97223 Footing drain (no. linear R: ) Page 2 Suite/bldg. /apt. no.: Project name: Pte(( (5 Manufactured home utilities 50.03 • Cross street/directions to job site: Varna Manholes 18.76 • Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Stoma sewer (no. linear ft.; __,J Page 2 Water service (no. linear ft.: 6�)5 1 Page 2 65.24 Subdivision: I Lot no.: Fixture or item: • Tax Map /parcel no.: Backflow preventer 31.27 Backwater valve 12.51 ]D ION. or WORiC _ • Replace existing water service. clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 A P .. ' E. T'ENANT . Expansion tank 12.51 Name: Mark & Taona Hollis Fixture/sewer ca p 25.02 Floor drain/floor sink/hub 25.02 Address:1 23 S tT) ? 6 Tk 4 e, Garbage disposal 25.02 City/State/ZIP: 1 1 r 4 r OQ" 7 1.2-3 Hose bib 25.02 Phone: (503)372-953Y Fax: ( ) Ice maker 12.51 - Il ::ATT.CICAN'�:.:: ' ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: M5 Plumbing Services 11c Medical gas (value: $ ) Page 2 Primer '12.51 Contact name: Pat Martinez Roof drain (commercial) 12.51 Address: PO Box 821143 • Sink/basinflavatory 25.02 City/State/ZIP: Vancouver, WA 98682 Solar units (potable water) 62.54 Phone: (360) 624 -8376 Fax:: ( ) Tub /shower /shower pan 12.51 E -mail: Pat@M5Plumbing.com Urinal 25.02 Water closet 25.02 CONTRACTOR' Water heater • 37.52 Business name: Same as above (Applicant) Water pipins/DW V 56.29 Address: Other: 25.02 City /SIB/ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: 184281 , /DI 2- 3 • I l 4 - P1 i g Lic. n.. P13 (i /114 Plan review (25% of permit fee) State surcharge (12% of permit fee) - 1.4 3 3 Authorized signature. � ����. TOTAL PERMIT FEE 73.07 r a r . .1.� Print name: Patrick Martin . RP: ate: 2/13/2013 This permit application expires if a permit is not obtained within 130 days after it has been accepted as complete. "Fee methodology set by Tri County Building Industry Service Board. T: 1Euldiec 1P°rmits1PLMU.PennitApp.doe 10/01/09 440- 4016T(10 /02/COM/WEB) • / • N 1- • • •I = 0 . It 1 H R • -1 71. V -C 1 0 4-. B 1G E E ai . ii ...... , . co. 1 41.J1 , 4 71 • .1 -, I -.:1 ••••1 :•1 - .1•: . .. , U, ± a) $ g p N4 • .41b. v. .,- in Br • . . . . . . . : . . . . . • • ' 0 .• in -111r -.* 4 01k 4V4Ii • . • . • . . - • ‘ . . .• ik , 1 tm a e . '5 R-.1 c a) win - a) at L =3 o at - NI .•. : :r - cityk5AsThr,r. , .. .• •,+. Tr . . • ' 4 • `'\:1 ).9i.."•,: 1 . 4 1-r - 1, 'V ' ; . 1.'.'irlif.,4.'1".0.3.,';•i:kx-YA........ g.. ,, • . c;," "kpg,...'jc % :. •• .. . . ..A4,,. ,. 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