Permit CITY OF TIGARD PLUMBING PERMIT
i . COMMUNITY DEVELOPMENT Permit#: PLM2013 00319
T!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718.2439 Date Issued: 09/16/2013
Parcel: 2S103AD07700
Jurisdiction: Tigard
Site address: 12676 SW 108TH TER
Project: WISDA Subdivision: MILESBROOK Lot: 8
Project Description: Shower pan replacement.
Contractor: WALKER PLUMBING CO Owner: WISDA,JANE
920 CAPILANO CT 12676 SW 108TH TER
LAKE OSWEGO, OR 97034 TIGARD, OR 97223
PHONE 503-288-5593 PHONE.
FAX'
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 09/16/2013 $12 51
Specifics: 1 12%State Surcharge- 09/16/2013 $8 70
Plumbing
Type of Use: SF 80 ea Minimum Fee Adjustment- 09/16/2013 $59 99
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: / i •ermittee Signature:
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 14 01 04:46a WALKER 5032885595 p.1
Plumbing Permit ApplicVECE�i►E1�,
T
Site Utilities l ll --, .: _- FOR OFFICE'USE 'ONLY
Y 3i W Ha Tigard ', 1 6 2013 Received / n ,..3. pill/
-r SEP Date/By: f/// // Permit No. 1V M V
131_5 SW Hall Blvd.,Tigard.OR 972_ Plan Revlc�� f /1
Phone' 51)3.718.2439 Fax: 5�1sf yi TIGARD Olhzr Permit�o
DatcBy:
Inspection Line" 503.6394175
"Elf... nR° BUILDING DNISION Date Ready;By. )ur c 0 Sc e Page 2 for
Internet WNW;tigard-or goy Notified/Medial % .1, Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑ Demolition For special information use checklist
Description I Qty I En I Total
®Addition/alteration/replacement ❑Other: New l-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath i 312 70
i
® l-and 2-family dwelling ❑Commercial/industrial SFR(21 bath 437.78
❑ Accessory building SFR(3)bath 500.32
❑ Multi-family
Each additional bath/kitchen 25 C2
❑ Master builder ❑Other:
Fire sprinkler( sq.ftl Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: I
Job site address: 12676 SW 108'Terr Catch basin or area drain 18.76 _J
City/State/ZIP: Tigard.Or-97223 Drywcll.leach line,or trench drain 18.76
Footing drain(no.linear ft _) Page 2
Suite/bldgJapt.no.: Project name:Wisda 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
Wafer service(no.linear ft. _) Page 2
Subdivision. Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12 51
Shower pan,drain Clothes washer 25.02
Dishwasher 25 02
Drinking fountain 25.02
Ejectors/sump 25 02
III PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name.Jane Wisdn Fixture/sewer cap 25.02
Address 12676 SW 108 OR terr Floor drain/Iloor sink/hub 25 02
Garbage disposal 25 02
City/State/71P:Tigard,OR 97223 1-lose bib 25 02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Walker Plumbing /'.L inu.m-Ir co ,QO4e'OCL. Medical gas(value:S ) Page 2
' Contact name: Brent �Q��; 5jr77j 5k(v 2-g07� Primer 12.11
fl '(Os (oZIL Roof drain(commercial) 12.51
Address: Slnklbasin/lavatory 25 02
CityiStatc.!ZIP• Solar units(potable water) 62.54
Phone. (503)2604545 Fax::( ) Tub/shower'shower pan 1 12.51 12 51
E-mail:rxwalker@anl.com Urinal 25.02
Water closet 25_(12
CONTRACTOR
-
Water heater 37 52
Business name:Rex Walker Plumbing Water piptng/DW V 56.29
Address:920 Capilano Ct LakeOswego Other: 25.02
City/State/ZIP:97034 Subtotal 12 51
Phone (503.)2885593
/x:
( ) Minimum permit fee: $72 50 72.50
Plan review (25%olpennit fee)
CCB Lie.-48603 felt/jy Plumbing Lie.no..26-82pb "7 r/l State surcharge(12%ofpemut fee)
Authorized signature: y7,14.4 a LI TOTAL PERMIT FEE et Z°
Print name Brent.lauch Date:9/11/13 This permit application expires 11 permit is not obtained within 18O days
after it has been accepted as complete.
E. "Fee methodology set by Tri-County 13ui'din.i Industry Service Board
I'13uiletnq',Permit..PLMU-PernuiApp doe 10101.yJ 4 40-76i CT(1nto:icoDNWEa)