Permit p CITY OF TIGARD PLUMBING PERMIT
s, COMMUNITY DEVELOPMENT Permit#: PLM2014-00371
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2014
Parcel: 2S102CA00944
Jurisdiction: Tigard
Site address: 9555 SW FREWING ST
Project: KIELING Subdivision: VILLAGE GLENN Lot: 44
Project Description: Water heater replacement.
Contractor: UNITED PLUMBING Owner: KIELING, COLE N
PO BOX 971 9555 SW FREWING ST
FAIRVIEW, OR 97024 TIGARD,OR 97223
PHONE: 503-752-8446 PHONE:
FAX: 503-491-8671
FEES
Quantity Description Date Amount
1 ea Water Heater 11/12/2014 $37.52
Specifics: 1 12%State Surcharge- 11/12/2014 $8.70
Plumbing
Type of Use SF 35 ea Minimum Fee Adjustment- 11/12/2014 $34.98
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 952E1-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or . .4.
Issued By: j ? Per ignature:
- iJ << Lea!
Call 503.639.4175 by 7:00 a.m.for the next available ins 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 Application
Building Fixtures FOR OFFICE USE ONLY
Ci of Ti and Received
g ,�VittV Date/B : i 4110 Permit No.. ` ' .� 7
UPI 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review /
= Phone: 503.718.2439 Fax: 503.598.1 Date/By Other Permit No.:
TIC A R n Inspection Line: 503.639.4175 N 1 5 2.014 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov w 1 Notified/Method: Supplemental Information
TYPE OF WORK • Vr + ` FEE* SCHEDULE
❑New construction ❑Dem. ' , ` 1 i For s,eclat in ormation use checklist.
Descri.tion 111M. Ea. Total
a Addition/alteration/replacement ❑ • '1% New I-2-family dwellings(includes 100 ti.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
14 I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: 9 1Sr 5:.ar # r e f�. i„4 S 1-
2 Drywell,leach line,or trench drain 18.76
City/State/ZIP: 'T J 1 G v 7 2 `/ v
r � Z 7 3 3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Kiel
t'iV Manufactured home utilities 50.03
Cross street/directions to job site: J Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
' Page 2
_
Subdivision: of no.: Fixture o
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Lt" ,1 r't v' 1-1 e.' -Y Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:
Fixture/sewer cap 25.02
Floor drain/tloor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: VI/�t -cc d Pit,ho 6i,� Medical gas(value:$ ) Page 2
Contact name: -3. C`,4 wt 2�/ Primer 12.51
-^t r� ��� Roof drain(commercial) 12.51
Address: P Cr.) 13 o' 971 Sink/basin/lavatory 25.02
City/State/ZIP: Ct; +Q-t..✓ 0 12 q 7 C 2 if Solar units(potable water) 62.54
Phone:(53) -75 2_ g tj Li G., Fax: :(,503) 111(1 j_ 6,6,7 1 Tub/shower/shower pan 12.51
E-mail:i yt c L� eyIt i ,,,-001,,),,6 i✓+/ L L-L . C0 1'4'. Urinal 25.02
CONTRACTOR Water closet 25.02
/ Water heater ' 37.52 3 7_ ja
Business name: t vu 1.1 1 el p i i./ n4 109 ✓" G Water piping/DWV 56.29
Address: l• 1 Other: 25.02
City/State/ZIP: Subtotal ?""). -)
Phone:( ) Fax:( )
Minimum permit fee: $72.50 '71.S`?)
I,2 S Plan review (25%of permit fee) _
CCB Lic.: to s i j - Plumbing Lic.no.: t1 State surcharge(12%of permit fee)
Authorized signature: I ey t TOTAL PERMIT FEE 0 . .'
Print name: TA. 5 CS y'. C IA, vvi b c\ Date: 11 ,Z I Iii This permit application expires if a permit is not obtained within 81 days
after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
I1 Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)