Permit (28) ` q CITY OF TIGARD PLUMBING PERMIT
•
r'7 COMMUNITY DEVELOPMENT Permit#: PLM2023-00421
Date Issued: 10/2/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110BD03000
Jurisdiction: Tigard
Site address: 14872 SW 116TH PL
Project: Wanderscheid Subdivision: HELM HEIGHTS Lot: 7
Project Description: Replace(1)shower pan.
Contractor: OWNER Owner: WANDERSCHEID,GARY A&
WANDERSCHEID, CLYDENE L
14872 SW 116TH PL
TIGARD,OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 10/02/2023 $12.51
Specifics: 1 12%State Surcharge- 10/02/2023 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 10/02/2023 $59.99
Class of Work: ALT 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 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
Issued By: Permittee Signature: ! �/ em'_i
Call 509.41 y 7:00 a.m.
6 for the next available ins tion 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 ADDlicatiLECEIVED
Site Utilities OCT 0 2 2023
City Received Permit No.:
SW Tigard 11M11)11.11=1111M111111.111
D„e�,. O 3 J PkA'i-�o3 -3 -d( 3
13125 SW Hall Blvd.,Tigard,OR��TY OF TIGARD Plea Review
;t
I'1.1 ' Phone: 503.718.2439 Fax: 503. $ !NG DNI T�'m/0y- Other Permit No.:
TIGARD Inspection Line: 503.639.4175 SION Date Ready,By: mils. ®See Page 2 for
Internet www.tigardor.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklistTotal
Description I Qt9.
❑Addition/alteration/replacement ix Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(__sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
r) Catch basin or area drain 18.76
Job site address'i Y i 'L. �' M t�C(�
� Drywall,leach line,or trench drain 18.76
City/State/Z1P: "'�' (t kbZ q( 7 ea)t9'I f' Footing drain(no.linear ft: ) Page 2
Suite/bldg./apt.no.: J I Project name: S/JOW f/1 - /4;4f Ba41. Mannftwtured 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
�ivs zyll New -hie. SAe./e^ Dishwasher 25.02
r, 25.02
L✓i{r �M1 �9rY� Flo FX !-�9.%V //3-Icy R�p�•'c. Drinking fountain
1- NI r//o fiif#✓- f'✓4-j.' Pt- a41i+h Aie,Hr be•+�` d Wei;
Ejectors/sump 25.02
Di PROPERTY OWNER I J ❑ TENANT Expansion tank 12.51
it/Mk/ea L {i Fixture/sewer cap 25.02
Name: �,�/ZG(�//1St-/!e/di Floor drain/floor sink/hub 25.02
Address:rv0 ?50 / IfS-A Pl pCe Garbage disposal 25.02
City/State/ZIP: 7 j 9/CJ/f d 0 R Q/tau q' Hose bib 25.02
Fax: Ice maker 12.51
Phone:(�7(%�)L//)3._./),-��,t ( ) 25.02
❑APPIICANT 0 CONTACT PERSON Interceptor'/greasetraP
Medical gas(value:$ ) Page 2
Business name:
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
Phone:( ) I Fax::( ) ii;tub/shower/shower pan 1 12.51
Urinal 25.02
E-mail. Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: Water piping/UW V 56.29
Address: Other: 25.02
City/StatelZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee)
I Authorized signature: TOTAL PERMIT FEE
Print name‘19 2 /r/U//} e This permit application expires if a permit is not obtained within 180 days
ftJAN®f'R S�R �D�pt/tiara 3 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I\Building\Petmits\PLMU-PemdtApp.doe 10701/09 4404616T(10/02/COM/WER)
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
C/Wy Icd✓AMvedzsciet11
Print Name of Permit Applicant
/0—�—90?3
ignat a of Permit Applicant Date
M 6n ua
Permit#: P� � D3 — 1 1 ,
Address: i 41- t1 (044.1 A_ 'q
9 f �' :y
Issued by: . Date: (b(: (a3 F.1
This Copy for Permit Offices