Permit { CITY OF TIGARD PLUMBING PERMIT
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a COMMUNITY DEVELOPMENT Permit #: PLM2010 00143
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2010
iT1GARD 9 Parcel: 2S102DB06900
Jurisdiction: Tigard
Site address: 9169 SW HILL ST
Subdivision: Lot: 0
Project: Nelson
Project Description: Master bath remodel
Owner: FEES
NELSON, DOUGLAS S /JEANNE M Quantity Description Date Amount
9169 SW HILL ST
TIGARD, OR 97223 2 ea Lavatories 04/30/2010 $50.04
PHONE: 2 ea Tub /Shower /Shower Pan 04/30/2010 $25.02
1 ea Water Closet 04/30/2010 $25.02
1 12% State Surcharge - 04/30/2010 $12.01
Contractor: Plumbing
JOHN D PLUMBING
7472 SW FIR STREET
TIGARD, OR 97223
PHONE: 503 - 620 -7600
FAX: 503 - 598 -9355
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
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 -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: /, 4 Permittee Signature: /
r " ,1 - OA/ /,7°P z./ 69-7---70 /
CaII 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.
APR -28 -2010 09:44A FROM: JOHN D. PLUMING C503)598 -9355 TO:5035981960 P.1 �!ff
Plumbing Permit Application U d
/� 'Fixtures ,per i r or ,. ♦ " 'rp ' . . S 4f pub. ' T i f- ; ?, $"i5 € ',t � ^ , °s t i ± ..
Building ' ixture4 i Jr �h �t 1 ���.W i�l i�� iri it iX��x�i�5 �i 4 � y� d .
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� ` t City of Tigard q 3d i0 , w®t Ne,,op _ 0 0 - i /
- 13125 SW Hail 9Ivd., Tigbxd, OR q Q Has Rsaew
ii- _ f a E Phone: 503.639.4171 Fax 503 0 ilI o mss, Other Permit Putze,20 /O -60
eel,- 4 Inspection Lint: 503.639.4115 DM 1 dY '- See Pegs 2 far am
li: 'r li axmet: www.ngnrd or.gov CITY OF TIGARD PP�e •
�;:° �' t'loti fwdlMethod:
TYPE ®* 4 dMNG DIVISION FEE* SCHEDULE
0 New cum Muctiun ❑ Demolition Far wild Warmth= sass dadaist
Description F Qty. 1 Eo. 1 Tote!
114 Additiaieltaotion/fepIactmart ❑ Other. New 1- 2- 11am11y dwellings (inctudn 100 ft. for melt utility cormeeti(n)
CATEGORY OF CONSTRUCTION SFR (I) herb 249.20 -
1- and 2- fhmily dwelling 0 Commenaal/industriai SFR (2) bath 350.00
0 Accessory building ❑ Multi - ily SFR(3) bath 399.00
fam
Each additional balh/Idtthen 45.00
[] Master builder ❑ Other. Fire sprinkler L_ aq. ft.) - Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
lob site address: q t Fj 1 5 (A9 +f (LL Si- Catch basin or area drain 16.60
city/st rzwP: `11 2 R. b / 0 R • 9 1 22. 3 Drywell. leach line. or trench drain 16.60
Suite/bldg. /apt. nn.: 1 Project name Footing drain (no. linear ft.: __, J Pegs 2
Cross s t/dire c inns to jot sits S (, j 0 (- f .A42. 4 2,''r' To M�uibcturod home utilities 110.00
Manholes 16.60
S ( A 9 +01-1- ST • Rain drain connector 16.60
Sanitary sewer (no. linear 11.: Page 2
Storm sewer (no. linear R: _) Page 2
Subdivision: Water service (no. linear B.:. Page 2
Tax map/parcel no.:
Fixture or heat
Absorption valve 16.60
DESCRIPTION OF WORK g, w s Page 2
PIASTER_ ib-kl - P.0 fO1at - (kJ '* Backwater valve 16.60
2 1.V KS r TD(uT TU(3 r S41'04,47 E2. Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER l ❑ TENANT Drinking fountain A 16.60
- - - Eject rs/aump 16.60
Name: Expansion tank 16.60
Address: 4 { � - I ) +4 11,4,... ST FixhorJa ewer cap 16.60
City /State /ZIP: 'rl Gr..2 b 1 (".)(z • 9'7 22:3 Floor drain/floor sink /hub 16.60
Phone: ( ) I Fax: ( ) Outage disposal 16.60
1.3 APPLICANT ❑ CONTACT PERSON Hate bib 16.60
ice maker 16.60
Wiliness name:
Interceptor/mesa trap 16.60
Contact name: Medical gas (value: S ) Page 2
Address: Primer 16.60
City/State/ZIP: Rouf drain (tnmmaciai) 16.60
~
Thane: ( ) 1 Fax: : ( ) Sintt/hffitMavalOTy 2. 16.60
7bbkAwwsel hewer psa ' '2. 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet I 16.60
Bimintse name: •t�/ rl QJ � S - - P(, V M M' W G Water bosun 16 60
Address: ! K 2 K o - FIR_ ST. -
C i t y / S l a t e / Z I P : 11 6 P-Q b ( Ott • .t 7ZZ 3 sabtot ,83.
I 1 Ph (T03) 02-0 -- /6 00 ( q - 03 9191,:f _Gi 3 minimum it fee. V2.50
� * J I 0_ Fax: Residential bsoltflew minimum it fax S3bZ5
U 1 CCB Inc.: 8� 53 ( 3 ( - , Plumbing Lic. no.: 3l'(- m f'(e Plan review (25% of permit ties)
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Authorized signature: ../ of permit State surcharge (12% fee) ge
ES . / , I . 7 ( (( TOTAL PERMT FE (2 . ( 0
Prim name: • n ; 1y OM (R, Dope: 'IiZZJLLJ Thu permit apptteatlon expires If a permit Is not obtained wttliln 1
ISO days after It law been accepted es complete. ✓
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