Permit y CITY OF TIGARD PLUMBING PERMIT
III I: • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00169
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2013
Parcel: 2S 104CA08100
Jurisdiction: Tigard
Site address: 13266 SW 136TH PL
Project: Mangum Subdivision: HILLSHIRE Lot: 81
Project Description: Bathroom remodel, (1) toilet, (1) lay and (1) shower
Contractor: M5 PLUMBING SERVICES LLC Owner: MANGUM, DANIEL K & STACY A
PO BOX 821143 13266 SW 136TH PL
VANCOUVER, WA 98682 TIGARD, OR 97223
PHONE: 360 - 624 -8376 PHONE
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 06/05/2013 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 06/05/2013 $12.51
1 ea Water Closet 06/05/2013 $25.02
Type of Use: SF 1 12% State Surcharge - 06/05/2013 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 06/05/2013 $9.95
Occupancy Grp: Plumbing
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 Not : 'e - - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. / You may •,%fain a copy of the rules
or dire questions to OUN► b • ling 51 .232.1987 or 1 800.332.2344.
Iss 'ed By: , 4 `/ / Permittee Signature:
4s/Y
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.
.
C � 415/50
,�O" 6 / r '6�,/ Plumbing Permit Applicatio.RECEIVE P1.1 ,94/3 -ee/6
• :mss; t hone: 503- 846 -3470, Fax: 503 - 846- 39q n c Request: 503- 846 -3699
155 N. 1 s AV, Suite 350 -12, Hillsboro, OR 97124 www.co.washington.or
',UGC* Current Planning Approval: Project # CITY OFTIG it #
TYPE OF WORK BUILDING DIVISION
FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
S i ddition/alteration/replacement 0 Other: New 1- 2 family dwellings (includes 100 ft. for each utility connection)
J` CATEGORY OF CONSTRUCTION SFR (l) bath 362.50
'J- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 465.50
❑ Accessory building ❑ Multi- family SFR (3) bath 566.50
❑ Master builder ❑Other: Each additional bath /kitchen 100.00
JOB SITE INFORMATION AND LOCATION Fire sprinkler (# sq. ft ) By sq R
Site utilities
Job site address: j S lQ/ Ia1 Catch basin or area drain 16 50 •
City /State /ZIP• - 1' i q cutd 732 Drywell, leach line, or trench drain 16.50 . '
Suite/bldg. /apt. no.. t Project name: ..40111 Footing Drain (each 100'mcrement) 48.50
Cross street/directions �16LO - A Aj")0 ons to job site: ' r n i Manufactured home utilities 110 25
La. Manholes 16.50
r6 f uc pl• V Rain drain connector 16.50
Sanitary sewer (each 100 ft.): # of ft 48 50
Subdivision. Lot no : Septic Connection 34 00
Tax map /parcel no.: Storm sewer (each 100 ft) # of ft 48.5
DESCRIPTION OF WORK
Water service (each 100 ft ). # of ft 4850
Fixture or item
1•46.r4. ^'q + �°'l 'CI rfrattgik'Q% G lam` Absorption Valve 16.50
�aa rt Backflow preventor 16.50
Backwater valve 16.50
Clothes washer 16 50
❑ PROPERTY OWNER ❑ TENANT Dishwasher 16 50
'A A _ Drinking fountain 16.50
Name: ge,WA
JJ / / Ejectors /sump 16 50
Address• i3 a /,,,(‘ S �, / ?t ` P1, Expansion tank 16 50
City /State /ZIP: ^M ^ ,� V� Fixture /sewer cap 16 50
Phone: ( ) _ `^' \ Fax: ( ) Floor drain /floor sink/hub 16.50
et APPLICANT ❑ CONTACT PERSON Garbage disposal 16.50
Business name: d� +` �t�..1 , _�'r S - Hose bib 16.50
{ `"' X74 �� Hydroponic piping system 16.50
Contact name: ) €SS i 1/4. AO , µ• t 4&,� Ice maker 16.50
Address: A. q 0 Rs , E, 1.- Interceptor /grease trap 16.50
City/State /ZIP: Grey . 9103o Medical gas (value: S ) By Value
Phone: (C77O e2 f i-T6 CFt Fax:. ( ) Primer (s) 16.50
Residential Re -pipe: 3600 sq.ft/less 105.00
E - mail: M gS L - _. 1 osA,LJQ 0_, Gy Cc. . N Zt
Residential Re -pipe: 3601 sq ft/more 158.00
CONTRACTOR Roof drain (Commercial) 16.50
Business name: !•�i142
��� �, I i Sink/basin/lavatory I� 7v
� i
Address Q -.r �xZt \ 43 Tub /show /shower pan ) 16 50 ( jam. �. /� 51
City /State /ZIP: v W >� ca-t- Urinal 16.50 6
r> v`c z I
[ G Water closet I 16.50 �•
Phone:g(6,CP (p2 D3 76, Fa x ( )
Water heater 16.50
CCB tic.: (v4 Z$ I x 7 4^6 Lic. no.. ' Other:
40
Authorized signature:
Subtotal
„��� �: y� . ...� /, Minimum permit fee $.14-54444--,7:4;15t Print name _ Date: Plan review (65% of permit fee) $ -
This permit application expires if a p • mi is not obtained within 180 days after it has been State surcharge (12% of permit fee) $ g'.0
accepted as complete. * Fee methodology set by Tri -County Building Industry Service TOTAL PERMIT FEE $ q/ •,9z
Board. S: \FORMSUuly 2012 forms /Plumbing Permit Form rev 06 -12 doc
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13266 SW 136TH PL, TIGARD, OR, 97223
Residential - Plumbing
320 Plumbing rough-in
06/12/2013 00:00
PLM2013-00169
FAIL
1. Provide test on toilet and left drain for lav., all else ok. 723
Violation Summary:
Inspector Contractor