Permit (94) CITY OF TIGARD PLUMBING PERMIT
'J1 '{ COMMUNITY DEVELOPMENT Permit#: PLM2019-00163
TR RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/22/2019
Parcel: 2S 110AD04203
Jurisdiction: Tigard
Site address: 14615 SW 106TH AVE
Project: BUKRES Subdivision: LANG HILL Lot: D
Project Description: Adding and replacing fixtures for remodel: (1)dishwasher, (1)garbage disposal,(1) ice maker, (1)sink, (2)
tub/showers,and(1)water closet.
Contractor: INNER CITY PLUMBING INC Owner: BUKRES, MIWAKO
6470 NE HANCOCK ST 14615 SW 106TH AVE
PORTLAND, OR 97213 TIGARD, OR 97224
PHONE: 503-314-7313 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/22/2019 $25.02
Specifics: 1 ea Garbage Disposal 04/22/2019 $25.02
1 ea Ice Maker 04/22/2019 $12.51
Type of Use: SF 1 ea Sink 04/22/2019 $25.02
Class of Work: ALT 2 ea Tub/Shower/Shower Pan 04/22/2019 $25.02
Type of Const: 1 ea Water Closet 04/22/2019 $25.02
Occupancy Grp: 1 12%State Surcharge- 04/22/2019 $16.51
Stories: Plumbing
Total $154.12
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 503.232.1987 or 1.800.332.2344.
Issued By: � - •••ature:
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
Building Fixtures $. FOR OFR II t SH: ON 1.1
Cityof Tigard t a sl ENED Received "" pennitNo.: ��� ....a.)/114
131SW Hall Blvd.,Tigard,OR 97223 plan R view Y," �/'�� ` t
II = Phone: 503.718.2439 Fax: 503.598.1960;��( Z 1 Date/By: Other permit No.:
r \�\ Inspection Line: 503.639.4175 �-+A Date Ready/By: Juris ® See Page 2 for
I Internet: www.tigard-or.gov 1<i l y O(' 1GARD Notified/Method: t L Supplemental Information
TYPE OF wo*JILDING DIVISION FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description Qty. I Ea. I Total
ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
Mgt-and 2-family dwellingSFR(2)bath 437.78
0 Commercial/industrial
SFR(3)bath 500.32
0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
1 q Lp)S w 10 6'11 Catch basin or area drain 18.76
Job site address: � -
Drywell,leach line,or trench drain 18.76
City/State/ZIP: "(-/Q1 A42,> , DIC• q 72_2-'I Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: z,, y. S Manufactured home utilities 50.03
Cross street/directions to job site: /0(per ,•r( C14'N r .i31'72(2y 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: l Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
_Clothes washer 25.02
+PD `TV/tE T ) /1-1--re--2 S Haw-e-A_ V'J 1"'5' Dishwasher J 25.02 A5-v;
k-N 7 1)R i4 I N �J� /1---7-1�1 U , ~Drinking fountain 25.02
Ejectors/sump 25.02
(PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: M 1 WA12-0 1e)(/It(ZC.5
Floor drain/floor sink/hub 25.02
Address: i (p(6- jW ID[QGarbage disposal ( 25.02 _5-;‘)?..
City/State/ZIP: `j-) a Y�I , on, cj 7 Z 2 J Hose bib 25.02
Phone:($;,)) 7.30 <1 D 3 Fax:( ) Ice maker I 12.51 / ,.5
0 APPLICANT NTACT PERSON Interceptor/grease trap 25.02
Business name: f Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory I 25.02 :(),}
City/State/ZIP: Solar units(potable water) 62.54
Phone:( j - Fax::( ) Tub/shower/shower pan 4 12.51 d..j')t}}.
Urinal 25.02
E-mail:
-- Water closet1 25.02 :,may
CONTRACTOR l37.52
Water heater
Business name: /KIN ell- Gl T,i Ptit s t 1,- 1 tel') Water piping/DWV 56.29
Address: .O Sipe i O C/ZO N I- 5Gc Y1 2iFA-C f_- Other: 25.02 _
City/State/ZIP: ?0 tt-T LOQ t,•fid , 012.... %/1-2-0 Subtotal 1)"?41
Phone:(QU-' ) '3 114 -73r3 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: ( 9 9 D 2. 1 l Plumbing Lic.no.: FL_ 1.3 L((p
State surcharge(12%of permit fee) ,I/co .5/
Authorized signature: Gliv,, , ,r, /� / TOTAL PERMIT FEE i/ , /A.
A OJ Z E-R ✓V `..-vv Date: if/L 2/i c/' This permit application expires if a permit is not obtained within 180 days
Print name: l.J L 1, !!! after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)