Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013 00281
T t GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/13/2013
Parcel: 2S 1038803500
Jurisdiction: Tigard
Site address: 12193 SW 125TH AVE
Project: Brown Subdivision: BROOKWAY Lot: 35
Project Description: Replace 50'of water service
Contractor: MR ROOTER OF PORTLAND Owner: BROWN, MELODY FRANCES
PO BOX 789 12193 SW 125TH
GLADSTONE, OR 97027 TIGARD, OR 97223
PHONE: 503-653-5301 PHONE: 503-590-2541
FAX: 503-653-5376
FEES
Quantity Description . Date Amount
50 If Water Service 08/13/2013 $62.54
Specifics: 1 12%State Surcharge- 08/13/2013 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment- 08/13/2013 $9.96
Class of Work: ALT
Plumbing
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 questio•. • a.• by calling 503.232.1987 or 1.800.332.2344.
Issued By: / ,lQ2/�,r„ /l 4 Permittee Signature:
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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.
Aug. 12. 2013 12:45PM No. 7644 P. 1
Plumping rermmt Application
Site 'Utilities 4ED FOR OFriCL• USE ONLY
City of Tigard � Receives /q 13125 SWHallBlvd_,Tigard,0 3 �� ��®�' '�' _Qo�g�
2 Phone: 503.718 2439 Fax: 503.598. 8 j . n\3 Plan Review Date/By: Other Permil No,;
T I C A R n Inspection Tine: 503.639.x175 pD Date Aeady/By: kris: E7 See Page 2(or
Internet: www.tigard-orgov , • Tl3l Notified/Meibod: Su.•Iemeatallnformadoo
-_ 7: wt7 o)W.j- _ = - - '°4 �y� �9J�>rilPlAr Jti ..
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❑New construction I♦ Demolition For special information use checklist
Description Qty. I Ea. I Total
Xi Addition/alteration/replacement ❑Other. New 1.2-fondly dwellings(includes 100 g for each utility connection)
- - -<_.. = Y a CQ:.ta:P aj;roe:clar15,. ri:-_:,. SFR(1)bath 312.70
VI I-and 2-family dwelling CI Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32 .
O Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other. Fire sprinkler( sq.ft) Page 2
"j__'. ... :......... II _,.I . .Gilt, --.. Site utilities:
Catch basin or area drain 18.76
Job site address G. I��j 5W ‘154-t- f�V P.•� Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7 1 scyck 0 p. 411
I �� Footing drain(no.linear ft.: Page 2
Suitelbldg./apt.no.: Project name: 4 J Qpu....)lJ Manufactured home utilities 50.03 -
Cross street/directions to job site: • Manholes 18.76
$C51- 5C-V%0 ks YY l.4 n in connector _ 18.76
,J Sanitary sewer(no.linear It: ) Page 2
Storm sewer(no.linear ft: ) Page 2
Water service(no.linear ft:53') ) Page 2
Subdivision: f Lot no.: Fixture or item: -
Tax map/parcel no.; Bacldlowpreventer 31.27
.a- - -,K -i- - - � --t..'-r•-- _ - ac ter valve
12.51 ,
- .: - _DE5 r° .` .ice
R D VA�.R.. $0 I Clothes her 25.02
D rr w A-"F'Q V• 5 Q5(v:CR) Dishwasher 25.02
•
Drinking fountain 25.02
Ejectors/sump 25.02•_.� . id°a• d) •aty p e�A I .---...-_;:-,-t •_ E ripmc_ „= Expansion tank 12.51
Name: Me,1Oct" t3v-pwv-N Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: _• • a . . . Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:(SO3) b- 'z 5 IA\ Pax:( ) Ice maker 12:51
- y." a T .=-, -- =_- ;i �r Interceptor/grease nap 25.02
Business name: Medical gas(value:S ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: „t2_ (.brNA r o, -}O v Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax;;( ) Tub/shower/shower pan 1251
E-mail:ant t 1 rive 1'Ot7\-erfi 0Y{l4 • C OtM Urinal 25.02
�--- Water closet 25.02
/� t� "" - - Water beater 37,52
Business name: Mr. (ZDo+fir i t�yl Waterpiping/DWV 56.29
Address: PO Box ri g q Other. 25.02
City/State/ZIP: G k -0�� q�R G 16-1-1 _ Subtotal 7a,SC
E. S
Phone:(JC' 53.. t •Fax:(SO3)Gs-SS-1 cm Minimum permit fee: 572.50
_ Plan review (25%of permit fec)
CCB Lic.: 151/.114 ` Plumbing Lic.no.: 3M'314 Pe State surcharge(12%afpermit fee) i.70
Authorized signature: ti---- TOTAL PERMIT FEE gj/.go
I Date:Print name; ACS Oy ���I 3 I This permit appllcodoo expires if a permit Is not obtained within 180 days
Oyu-*112-S S.lr after it bas been accepted as complete. (c"A�17
'Fee methodology set by Tri-County Building Industry Service Board.
1:`Bmidmg\PermuuPL41U-Pe mitADpdoc 10/01599 440a616T(IOi02/COMJWEB)