Permit CITY OF TIGAR® PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00093
7 I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/31/2010
Parcel: 2S110AD90020
Jurisdiction: Tigard
Site address: 14866 SW 109TH AVE
Subdivision: CANTERBURY WOODS CONDOMINIUM Lot: 20
Project: HSBC BANK USA TR
Project Description: Install tub /shower.
Owner: FEES
HSBC BANK USA TR Quantity Description Date Amount
BY RECONTRUST CO, 400 COUNTRYWIDE
WAY SV -35 1 ea Tub /Shower /Shower Pan 03/31/2010 $12.51
PHONE: 1 12% State Surcharge - 03/31/2010 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 03/31/2010 $59.99
Plumbing
Contractor:
CROWN PLUMBING
5429 SE FRANCIS ST
PORTLAND, OR 97206
PHONE: 503 - 771 -9449
FAX: 503- 771 -9454
Type of Use: SFA
Class of Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: • ' 11 ` 1 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Plumbino Piermit Application .
.
Building Fixtures
FOR OFFICE USE ONLY :
• City of Tigard MAR 31 20
' rceived
_ . I , Permit No.,Rrrv,.Qacm__
. 13125 SW Hall Blvd., Tigard, OR 97223
111 )ale/Rv:
Plan Review
Phone: 503.639.4171 Fax; 503.598.1960 '„` , 'f . ) , Date/Ily: Other Pennii N
T IGARD o •
___f_____L_____,1_______
inspection Lire: 503.639.4175
i .•, ;r- • .,,:::, -.0.91,0, Ready/liy. ! twil El See Page 2 for
Int.e.rnel.: \WAIL ti gard-or..9,0V
' ' - • NOtifi4/MC1110: 11 i Supplemental Information
TYPE OF WORK
Fr viLi. .ut inn use checklist.
_____. ...____
E Description
m
New construction 1 r ifi Demolition
New 1- 2-family dwellings (includes 100 0. for each utility connection
1
___T
Af Addition/alteration/replaceme er: nt I L_I Oth
SFR (1) bath
1 249.20
_
_
CATEGORY OF CONSTRUCTION r SFR (2) hath
1 350.00
_ _____ ---•- _________
_,
mm
1- and 2-farnily dwelling I D Coer SFR (3) bath 399.00
cial/inclustrial
r---) Each additional bath/kitchen 45.00
0 Accessory building Multi-(amily
_ Fire sprinkler ( _ fi.)
n-
0 Master builder I Other:
Site utilities
______ _r_________
• JOB SITE INFORMATION AND LOCATION
Catch basin or area drain 1 16.60
_ ____r_
Job site address: / yp ‘ 4 S Li / 0 , i- L. A v -t- Drywell, leach line, or trench drain
_ . 16.60
_
Footing drain (no. linear 11.: ) Page 2
City/State/ZIP: - , t , _,_ j 6 Tr 9 7 Z2 _
- - -7 - `"- --
Manufactured home utilities 110.00
Suite/bIdglapt. no.: 1 Project name:
-- -
----
- - Manholes
16.60
Cross street/directions to job site:
• Rain drain connector I 16.60
Sanitary sewer (no. linear 0.: ,..,_ ) Page 2
_ _
Storm sewer (no, linear ft: ) Page 2
Water service (no. linear 0.: ___) Page 2 1
_
, _
Fixture or item
Subdivision:
L Lot no.: -
Absorption valve.
16.60
Tax map/parcel no.:
Backflow proven ter Page 2
_
DESCRIPTION 01 WORK
, 1 Backwater valve
16,60 -
" Clothes washer
(6.60
. ----1 1
Drinking fountain 16.60
16.60
Ejeciors/sunip
16.60
0 PROPERTY OWNER
J E..] TENANT
L I,xpansion tank
1 (6.60
_
---
Name:
I Fixture/sewer cap
16.60
-
Address:
, oor clrain/floor sink/hub 16.60
, ' , ...i....,_4.■-■; ,..1.: --- :LLLlaL.::,11 Fl
---
Garbage disposal ____r. 16.60
City/State/Z1P:
_
Hose bib
16.60
Phone: ( ) ,.' Fax: f, )
-----------
i
16 60
•- APPLICANT • . ' r - in 6CMITAGt PERS014 - Ice maker
Inlerecptor/grease trap 16.60
Business name: Christian Plumbing inc. DBA Crown Plumbing
- Medical gas (value.: 5 ) Page 2
Contact name: Dennis Underwood
Prima '
16.60
Address: 5429 SE Francis Street
Roof drain (commercial) 16.60
City/State/Z1P: Portland, OR 97206
Sink/basin/lavatory 16.60
_ -----
-
Phone: ( 503 ) 771-9449 i I Fax: : ( 503 ) 771 ----1 '11lb/shower/shower pan
I 16.60
Urinal
E-mail:
_ 16.60
_
CONTRACTOR
r _Water c;osel 16.60
, .
...... , --i
L Water heater
1 16.60
Business natne: Christian Plumbing Inc. DBA Crown Plumbing
other:
Address: 5429 SE Francis Street
-
_
Subtotal
City/State/Z1P: Portland, OR 97206
_ minimum permit fce: $72.50
__
Phone: ( 503 ) 771-9449 i Fax ( 503 ) 771-9454 Resiciential back, flow MillIMUIll i)ZrMit, fee: $36.25 7
-. - - i • - ____ ._1-----1
Plan review (25% of pennit fee)
E-mail: 1 Plimthing. lic : 34...7f)pg ....
_ --
State surcharge (12% of permit lee) e. 70
CCB lic.: 42671 1 Citv or metro tic. no. Me' e 431 ---
. 1
__......._____
TOTAL PERMITLE
Authorized / ed
_____ ,,),, permit application expires if a permit is not obtained within
..-
signature : . ‘,. ■.
_ 180 days after it has bun accepted as complete
...-
- -- ' methodology set by "Fri-County Building Industry SCI*ViCe 130ffi'd
Print name: Dennis Underwood I Dau.c: 3/ 0 i E - N . 1
1'1131:Ming \ Permits \ Pl.,51F-Pc,rm A pp.doc 11
•740-.46 i<i'r(, I M2/COM/WER)