Permit (226) CITY OF TIGARD PLUMBING PERMIT
v . . COMMUNITY DEVELOPMENT
1111
Permit#: PLM2016-00623
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/22/2016
T f 4 �Akt. Parcel: 2S104BC01200
Jurisdiction: Tigard
Site address: 14504 SW FERN ST
Project: MOON Subdivision: HILLSHIRE HOLLOW Lot: G
Project Description: Relocating(1)water closet and(1)shower,and adding(1)outdoor shower.
Contractor: ROTH HEATING&COOLING Owner: MOON, STEVE W&CALLIE L
PO BOX 1265 14504 SW FERN ST
CANBY, OR 97013 PORTLAND, OR 97223
PHONE: 503-266-1249 PHONE.
FAX: 503-266-3478
FEES
Quantity Description Date Amount
2 ea Tub/Shower/Shower Pan 12/22/2016 $25.02
Specifics: 1 ea Water Closet 12/22/2016 $25.02
1 12%State Surcharge- 12/22/2016 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 12/22/2016 $22.46
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 e rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0490. Yo may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
__ A
Issued By: A.„7",e2......
Permittee Signature:
r
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.
Plumbing Permit Application
�"1 FOR OFFICE USE ONLY
� Received
City of Tigard t. Date/By: jyr /2Q- `(/ Permit No.:A/12 j( Cv(0�3
13125 SW Hall Blvd.,Tigard,OR 9 - ,.) Plan Review YY7x�GG
Phone: 503.718.2439. Fax: 503.59 t5` ' •
Other Permit No.:
Date/By:
T I G A RD Inspection Line: 503.639.4175 41:1°� Date Ready/By: .auris: 0 See Page 2 for
Internet www.tigard-or.gov L 1'Noti•
fied Method: Supplemental Information
❑New construction ❑De o,
"`i'I �,iN ' , For special information use checklist
" q '' " Description Qty. Ea. I Total
®Addition/alteration/replacement ❑o AV- New 1-2-family dwellings(includes 100 ft.for each utility connection)
� ' y'S SFR(1)bath 312.70
"'-',• '.�,;,, i ,- i iiia s, .
® 1-and 2-family dwelling ❑\Commercial/industrial
SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
Ay � i n - � i iW,', .. ' Site utilities:
Job site address:14504 SW Fern St. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR.97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name:p100.AS 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
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
' mmv ktAI ``li,
~Backwater valve 12.51
� . Clothes
washer 25.02
Relocate toilet and shower.Add outdoor shower. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
nn raM/ v• i .. '' EXP ansion tank 12.51
Name: �5 i_ '- (7,..411‘,c, Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
\ f • ; r i Interceptor/grease trap 25.02
e 2
Business name:Roth Heating and Plumbing Medical gas(value:$ ) g
Primer 12.51
Contact name:Kirk Garvey
Roof drain(commercial) 12.51
Address:6990 S Anderson Rd. Sink/basin/lavatory 25.02
City/State/ZIP:Canby OR,97223 Solar units(potable water) 62.54
Phone:(503)266-1249 Fax: :(503)266-3478 Tub/shower/shower pan 2 12.51 ,23-4.7.2.
E-mail:kirkg@roth-heat.com Urinal 25.02
,,,,,,,7;:.
/ �y
Water closet 1 25.02
,1,5
:•ti ` .w, , .. � �� . o Water heater 37.52
Business name:Roth Heating and Cooling Water piping/DWV 56.29
Address:6990 S Anderson Rd. Other: 25.02
City/State/ZIP:Canby OR,97140 Subtotal 5-0, C/f
Phone:(503)572-8208 Fax:(503)266-3478 Minimum permit fee: $72.50 7
CCB Lic.:14008 Plumbing Lic.no.:3-450PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) D .'Ica
Authorized signature: TOTAL PERMIT FEE
'5,a 0....rvv-ty-
T1,d,,,
Print name:Kirk GarveyDate: 12/22/2016 This permit application expires if a permit is not obtained wit m 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)