Permit C ;., ; PLUMBING PERMIT
. CITY OF TIGARD
i COMMUNITY DEVELOPMENT Permit #: PLM201000128
a :r; .., :(17.1i, Date Issued: 04/23/2010
lai: 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 102CA00242
Jurisdiction: Tigard
• Site address: 13280 SW ASH DR
Subdivision: VIEWCREST TERRACE Lot: 3
Project: Watanabe
Project Description: Replace tub and toilet
Owner: FEES
WATANABE, JANICE E Quantity Description Date Amount
13280 SW ASH DR
TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 04/23/2010 $12.51
1 ea Water Closet 04/23/2010 $25.02
PHONE: 1 12% State Surcharge - 04/23/2010 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 04/23/2010 $34.97
Contractor:
Plumbing
JACK CORMAN PLUMBING INC
7483 SE JOHNSON CREEK BLVD
PORTLAND, OR 97206
PHONE: 503 - 788 -6947
FAX: 503- 788 -6949
Type of Use: SF
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 b ailing 503.246.6699 or 1.800.332.2344.
A, ,,
Issued By: Permittee Signature: 61-n---
iz
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.
04/21/2010 08:46 5037886949 JACK CORMAN PLUMBING PAGE 01/02
RECEIVED
plumbin ]Pielrmit A . lication APR 2 1 ' a . ` '' :, . ' .4 ; �,:�i_3 � y�
Internet: wwW.ttgard- or�gov
r :, r City f Tigard Re`s Permit No.: pt o[ O (� dog 2- M ` ni 131 SW 1401 Blvd.. Tigard, OR 972Vi OF TIGARD r1n„ Review
r' Phone: 503,639,4171 Fax: 503.51r�fI DING DIVISION naro/ey, rnllorlrennn
�e ;, +tie - Inttpeetion Line: 503.639.4175 v iL Dntc Rendy113y: Auk: Id Sec Pa 2 for
X 41, r;: lt;E , Notifitxl/Matl+ed: Supplemental Information v
ifs .r.n s it
eg; �i�1 /i TYPE OF WORK FEE" SCHEDULE ' . .l ,
0 Demolition For .c mitt! in om otton sae checklist.
❑ 'New construction _ Deacri -tion 1=11 Ea. Total
_ Addition/alteration/replacement ❑ Other: Now 1- 2- famtlY dwellings (includca 100 ft for each utility connection)
- 4° '1 6
1i» Y CATEGORY OF CONSTRUCTION SFR (1) both 249.20
s.
1 -and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
SFR (3) both 399.00
Accessory building Multi - fancily
g Each additional bath/kitchen 45.00
[] Master builder l ❑ Other: Fire sprinkler ( sq. 11.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: Ir. 0 ' S V \ Dqr , C atch basin or arcs drain IIIIII 16.60 NINON
City/State/ZIP: It k i ,,I L Drywc11 each line, or trench drain 16.60
Suite/bldg. /apt. no.: Project nam : footing drain (no. Linear ft.; ) Page 2
Ivfanufaotured horno utilities 110.00
Cross street/directions to job site. _ _ Manholes . IIII 16.60
Rain drain connector 16.60
Sanitary s ewer (no. linear 11.: ) Page 2
Storm sewer (no. linear 11 .: � Page 2
Water service (no. linear ft.:. ) Page 2
Subdivision: Lot no..
Fixture or item
Tax map /parcel no.: Absorption valve 16,60
`>; %r . ; DESCRIPTION OF WORK •
y Baokflow prcvcntcr Page 2
le i k ` ,, LI A °l"' 4 \g Backwater valve 10.60
Clothes washer 16,60
-" - Dishwasher 16.60
Drinking flxmtain 16.60
i ;jr1 plkOpERTY OWNER ❑ TENANT
. Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) - Fax: ( ) Oarhnge disposal 16.60
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON tcc maker 16.60
Business name: Inicrccptor /grease trop 16.60
Contact name: _ Medical gas (value: 3 ) Page 2
Address: T Primer 16.60 MEI
-
City /State /ZIP: - Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
� r�
.�. 1 _ V .
Phone: ( ) ( )
Tub/shower/shower pan 16.60 �(' ' d
E -mail: Urinal 16.60
,,:: CONTRACTOR Water closet I 16.60 1, e.ILO
BusincSS rlamc 4,„ 03 a xnto, t Water heat - 16.60
Address: i �� : Other: Subtotal
City/State/ZIP: MIL d, O 1t0( ,,,,_ minimum permit fee. $72,50 ''} ,-7�
Phone: 503) •
• • =! ��k I� Fax: � 1 s-3 ( Residential backflow minimum permit fee: 336.25 ` -emu
- Plan review (25% of permit fee)
CCBLic.: 6 - \ .,/91 Plumbing l 9
f State surcharge (12% of permit foe) ` , .0
Authorized si . ` /tom TOTAL PERMIT FEE, '"Z
- 0
E !�1 .1
Fiat name: i ' ninip ec Date: +42,1 .1 O'i This permit application expires lra permit Is not obtained within
. ISO days alter it has been accepted as complete.
"Fee tnethodoloRy set by Tri-County Building Industry Service Board.
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