Permit (9) CITY OF TIGARD PLUMBING PERMIT
712.. .j COMMUNITY DEVELOPMENT Permit#: PLM2016 00537
T[ 1 R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/26/2016
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Parcel: 2S114BA01200
Jurisdiction: Tigard
Site address: 16145 SW GRIMSON CT
Project: MONROE Subdivision: PICK'S LANDING NO.2 Lot: 127
Project Description: (1)clothes washer,(1)sink,and(1)shower for a 578 sq.ft.addition.
Contractor: BC PLUMBING INC Owner: MONROE, CONNIE LEE
PO BOX 1026 16145 SW GRIMSON CT
SILVERTON, OR 97381 TIGARD, OR 97224
PHONE: 503-845-4993 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 10/26/2016 $25.02
Specifics: 1 ea Sink 10/26/2016 $25.02
1 ea Tub/Shower/Shower Pan 10/26/2016 $12.51
Type of Use: SF 1 12%State Surcharge- 10/26/2016 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment- 10/26/2016 $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 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. or 1.800.332.2344.
Issued By: ,...0 /y" '"... " Permittee Signature:
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Call 503.639.4175 by 7:00 a.m.for the next available inspection dat .
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 FixturesIN
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City of Tigard ,\ Permrt Na
Received /�sn� ��i,
1111 . q 13I25 SW Hall Blvd.,Tigard,OR " . i, ri Pip Review/O /�6 J e¢ Ivy `L 15
Phone: 501718.2439 Fate 503.59 DarefB Other Permit No./Y072 0 i�,3?3
TIGARD
inspection-Lac 5016394175 0,
�.0 1 Date Ready/13y: halt: H See Page 2 for J
Internet www
_tigard-or.gev 111Notified/Method. 7 ion
11 ca Supplemental Information'
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TYPE'OF,WORK . r FEE*SCHEDULE -,
New construction ❑Deektt For special information use checklist.
f Addition/alteration/replacement Q Description 1 Qty. 1 Ea. I Total
New 1-2-faintly dwellings(includes 100 IL for each utility connection)
CATEGORY OF CON ON,, SFR_(1)bath I 312.70 i
Ll 1-and 2-family dwelling ❑Commercialfmdustrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 50032
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler(- sq.ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
SCarrh basin or area drain 18.76
Sob site address:
�614S Gv„ve,g a,�. c'T 5u,,
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -11 o,f . ey4i. C17 2 2 3
`` Footing drain(no.linear ft.: ) Page 2
Suite/bidg./apt.no.: Project name: --44ett 1 ' ` /M1�,ref l?Ti_ 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 f.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: P;c.f:s (-,c..;AC v.,s A/c; '2- Lot no.: i2•7 Fixture or item:
Tax map/parcel no.` Backflow preventer 3127
DESCRIPTION OF",'CYORR Backwater valve 22 51
Clothes washer .1 25.02 8 j„04
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
fl PROPERTY OWNER . Q TENANT Expansion tank 12.51
Name: Av. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 16 l N5 Gfcw,sc.A Cr Sc.✓ Garbage disposal 25.02
City/State/ZIP: "r. C,{,`f OV, crl 2Z 3 Hose bib 25.02
Phone:(563) Vic-( ,5o`•i Fax:( ) Ice maker 12.51
0 APPLICANT i CONTACT PERSON Tnterceptor/grease trap 25.02
Business name: ty �+ Medical gas(value:$ ) Page 2 -.
Primer 1251
Contact name: 6(, <f<<roti
t Roof drain(commercial) 12.51
Address: A) gyp,x 24C9S Sink/basin/lavatory A 25.02 957 C/ .
City/State/ZIP: kir'z ci o k Y?3 o7 Solar units(potable water) 62.54 /
Phone:(54;,3) c,,,/, /3 7'1 Fax: Gu�
( ) Tub/shower/shower pan l 12.51 57
E-mail: 0i/tUrinal 25.02
+"C , Water closet 25.02
N RACTOR
Water heater 37.52
Business name:'-at,, C.`:-pi t .t+"sb 3 t'i L-n O Water pip ng'DW V 5629
.Address. ,It. )4, 10 a Other: 25.02
City/State/ZIP: '��~ r I V e.4.--4-1:)Y"), , C:1 13.2 1 Subtotal (,,,) ,S j
Phone:( T 3) <45--499 3 Fax:(sn a'' -A ii O • Minimum permit fee: $72.50 70),5-r
-
CCB tic_: 1 al c;) 7/Jl fr Plumbing Lie.no.: ;14- pfS
Plan review (25%of permit fee)
afore: � // State surcharge(12%a of permit fee) ?"7
Authorized si
0 f 7 TOTAL PERMIT FEE S..7 )1)
Lei Print name: c- i - \ Date:(6-2.4-4,4,
Thi Permit application expires if a permit: not obtained within 180 days
e
` \Jafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1Building'Permrts\PLMU-PeunitApp.doe 10!41/e.9 440.4616T(10102/COM/WaB)