Permit CITY OF TIGARD PLUMBING PERMIT
11111 COMMUNITY DEVELOPMENT Permit#: PLM2013 00332
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2013
Parcel: 1 S134CB03900
Jurisdiction: Tigard
Site address: 12180 SW NORTH DAKOTA ST
Project: Pfeifer Subdivision: ANTON PARK Lot: 1
Project Description: Repipe house,water lines only.
Contractor: EXCELLENCE PLUMBING LLC Owner: PFEIFER
8269 SW CIRRUS DR 12180 SW NORTH DAKOTA ST
BEAVERTON, OR 97008 TIGARD, OR 97223
PHONE: 503-643-3459 PHONE:
FAX: 503-643-2815
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 09/24/2013 $56.29
Specifics:, 1 12%State Surcharge- 09/24/2013 $8.70
Plumbing
Type of Use SF 16 ea Minimum Fee Adjustment- 09/24/2013 $16.21
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 • ' -- ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or•'ect questions to O by calling 503.232.1987 or 1.800.332.2344.
Issued By: / /410I1 Permittee Signature: eel/
Call 503.639.4175 by 7:00 a.m.for the next availabl. ••-section 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.
Plumbing Permit Applic
C �
Building - =
Building Fixtures � FuK-OF-rice iESc-ONLY - - _. -
_
City of Tigard ) 2 4 Received 9 �/ / • p Permit No.. 'uy�,/3�3 -
■ 13125 SW Hall Blvd.,Tigard,OR 9 2013 Dat•Py:
Plan Review
Phone: 503.6.39.4171 Fax: 50,1598.1960 DataBy: Other Permit No.:
inspection Line: 503.639.4175
'fIGARI> I p/F�TIGAR® DateReady/3y: runt. 13 See Paige2for
Internet www.tigard•or.gov '� Notifie'/Method: I Supplemental Information
TYPE O�F IG DIVISIOe`i FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
rg. L Description 1_ Qty. T Ea. I Total
4ddition/aileratiotireplacemert ❑Other: -
New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
,,X1-and 2-;artily dwelling I ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)batl, 500.32
I ❑Accessory building I ❑Multi-family
Each additional bath:idtchen I 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.it.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: /2 ?O 5W �0 � 1 a,k.., 4 SY Catch basin or area drain 18.76
Dryweil,leach line,or trench drain j 18.76
�-�---
City/State/ZIP: I lq apoi Ok
/ Footing drain(no,linear It.: 1 I Page 2
Suiteibldg./apt.no.: Project name: T.4 j �l '-
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes I 18.76
Rain drain connecter 18.76
Sanitary sewer(no.linear H.:/) Page 2
iSrorm sewer(no.linear ft.: i Page 2
Water service(no.Linear r: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax trap/parcel no: Backflow prevent=: I 3I.27
DESCRIPTION OF WORK Backwater valve 1 12.51
Clothes washer I I 25.02
ke i p Dishwasher 1 25.02 •
Drinking fountain 25.02
Ejectors/sump I 25.02
❑ PROPERTY OWNER ❑ TENANT I Expansion tank . 12.51
Name: I Fixtine/scwer cap I 25.02 I
Address: I Floor drain/floor tint:/hub I 25.02
Garbage disposal 25.02
Cilv(State/ZIP: Firma bib 25 02
Phone:( ) i Fax:( ) i Ice maker I.Si
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 I
Medical gas value:S
Business name: ( �) Page 2
Contact name:
Primer I 12.51 I
Roof drain(commercial) 12.51
Address:
SinkThasinilavatory 25.02
Cir:Slate/ZIP:
y Solar units(potable winter) 62,5-4
Phone:( ). Fax::( ) J Tub/sshower/shower pan 12.5i
E-mail: I Urinal I 25 02
CONTRACTOR Vida.closet 25.02
Water heater 37.52
Business name: &-,cCel/r;Ce / !L C- I Water pipinc/DWV 1 56.29 I ,S6 29 Address: ¶2i Std' rU I^. ` Other: I 25.02 r
City/Stnte,`ZIP: Sea Vet-try)f Or 76G F. Subtotal i 5�r z`'t'
i 1^ JJ Minimum permit fee: S-2.50 ��7
Phone:(.5-03) pits~-3�5 Fax:(�lYJ) 695-28'15 7250
Plan review (x376 ofpenntr Tee)
CCB Lic.: 17576 7 1 3o pS Plumbing Lie.no.: /o 3 � 7�
/ Sane surcharge(12%of permit fee) t y
Authorized signature: _ j�� d y�71�l TOTAL PERMIT FEE i %1/ Z 0
Print name: /e� �' /j Date. /,sue® Th:a perarn ap co iaaoapire.if a permit in am obtained within 160da7a
ttttttttte���r�fuss after;rims been accepted a.s complete.
•Fee melbodology set by Tri-County Btr/ding Industry Service Scud.
I?Buildiog\Petruits\PLMU.Pcroit p?dec 122/C1109 oto-4615r(tacz'COSUWEB)