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Permit Support Document (31) qCITY OF TIGARDVBSEf M.� PLUMBING PERMIT Permit*: PLM2017-00281 COMMUNITY DEVELOPMENT TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/17/2017 Parcel: 2S103BB02200 Jurisdiction: Tigard Site address: 12175 SW 124TH AVE Project: Haynes Subdivision: BROOKWAY Lot: 22 Project Description: Moving existing 1 tub/shower, 1 sink,and 2 toilets. 7/25/2017: REPRINT permit to add the relocation of(1) existing shower. Contractor: AAPPLE PLUMBING Owner: HAYNES, DALLAS M&RACHAEL E PO BOX 1543 12175 SW 124TH AVE HILLSBORO, OR 97123 TIGARD, OR 97223 PHONE: 503-502-9916 PHONE: FAX: 503-647-2736 FEES Quantity Description Date Amount 1 ea Sink 07/17/2017 $25.02 Specifics: 1 ea Tub/Shower/Shower Pan 07/17/2017 $12.51 2 ea Water Closet 07/17/2017 $50.04 Type of Use: SF 1 12%State Surcharge- 07/17/2017 $10.51 Class of Work: ALT Plumbing Type of Const: 1 ea Tub/Shower/Shower Pan 07/25/2017 $12.51 Occupancy Grp: 0 12%State Surcharge- 07/25/2017 $1.50 Stories: Plumbing Total $112.09 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to 0 NC by calling 503.232.1987 or 1.800.332.2344. Issued By: � Permittee Signature: c7,,c, /770,00/._, Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Jul20 1701:13p Aapple Plumbing Inc. 5036482765 p.1 Plumbing Permit Application � �Sty n5 �� i Building FixturesREdivE FOR 01 FR. E. L St O\l.t City of Tigard Received 7 25// 7 --p is G%7o'�d/7"00 i,/ :l 13125 SW Hall Blvd.,Tigard,OR 97223 D�eJBy / Phone: 503.7182439 Fax: 50359$.196 L 2 0 2017 Plan ay 1CW Other Penult No.: Inspection Line: 503.639.4175 Date T i G'h D Internet: www.tigardor.gov CITY OF"6 1( k R D NOfified/6 etht o ' 7 ham: SJ See Page 2 for CITY jl I il.i!`1f� -717707 / _ Supplemental Information TYPE OF 'f. DING DIVISION FEE* SCHEDULE ❑New construction II 1 emomyon For del in ornraadon use checklist Description Qty. I Ea. I Total ®Additian/alteralion/replacentent ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 IS 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78 - ©Accessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other Fire sprinkler( sq.It) Page 2 . JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:12175 SW 124°Ave Catch basin or area drain 18.76 City/State/ZIP:Tigard,or Dty`ell,leach line,or trench dram 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldgfapt.no.: Project name:Haynes Manufactured borne 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 it.: ) Page 2 Water service(no.linear it: ) Page 2 Subdivision: Lot no.: : Fixture or item: Tax map/parcel no.: Backflow preventer 3127 DESCRIPTION OF WORK B valve 12.51 Clothes washer 25.02 moving one existing shower,to be added to existing permit 2017-00281 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 , 0 TENANT Expansion tank 12.51 ❑ PROPERTY OWNER Fixture/sewer cap 25.02 Name: 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 ❑ APPLICANT • 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:S ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Prone:( ) Fax::( ) Tub/shower/shower pan 1 12.51 12.5E E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:Aaappte Plumbing Inc Water PipinS/DWV 56.29 Address:31480 NW Hornecker Rd Other: 25.02 City/StaterZ1P:Hillsboro Subtotal 12.51 Phone:(503)648-1855 Fax:(503)648-2765 Minimum permit fee: 572.50 CCB Lie.:104311 Plumbing Lie.no.:34-308PB Plan review (25%of permit fee) Authorized signature I State surcharge(12%of permit fee) �" -� � �� �--- { TOTAL PERMIT FEE This permit appacatim expires if a permit is not obtained within 130 days Print name: ic2/-� J,J�- y? :7 r> / after it has hew accepted as complete. tet/ *Fee methodology set by Tri-County Building Industry Service Board. 1:1RuildingtPermitePLMt1-PematApp.doc 10/01)09 440-4616T(10102/COMAVEB)