Permit x CITY OF TOGAR® PLUMBING PERMIT
21 ^�;h a= r
r COMMUNITY DEVELOPMENT Permit #: PLM2010 00177
.` Date Issued: 06/03/2010
�TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S110DD10400
Jurisdiction: Tigard
Site address: 10990 SW HIGHLAND DR
Subdivision: Lot: 0
Project: Auerbach
Project Description: Add lav and shower pan for bathroom remodel.
Owner: FEES
AUERBACH, JACK & JOAN Quantity Description Date Amount
10990 SW HIGHLAND DR
TIGARD, OR 97224 1 ea Lavatories 06/03/2010 $25.02
1 ea Tub /Shower /Shower Pan 06/03/2010 $12.51
PHONE: 1 12% State Surcharge - 06/03/2010 $8.70
Plumbing
Contractor: 35 ea Minimum Fee Adjustment - 06/03/2010 $34.97
D & F PLUMBING Plumbing
4636 N ALBINA AVE
PORTLAND, OR 97217
PHONE: 503 - 282 -0993
FAX: 503- 288 -0604
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 que ' ABC by calling 503.246.6699 or 1.800.332.2344.
r
Issued y: , ( Permittee Signature ffifirjr:(�
...._ 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.
Plumbing Permit Appiica Fr <` 3_F' i -.. ...
_
at at+pY vM `�ri�wAt�S d� vw A s `
Building Fixtures 3 r * , � i F R , UFFlCE s' O�Z`c: ' to x * r
JUN 0 2 010 " , .,, _ vt,„„4 , ,, M „ N4 Mu M Eztf
r:44, " City of Ti Received �v�n` ,.t, �7
"� F + d P- 0No.. 'LI/OK w-60�7/
is 'r 13125 SW Hall Blvd., Tigard, OR OW OF i IGA D Da R
Phone: 503.639.4171 Fax: 5 Plan
(� ` ! w pr Date/By: OtherPennitNo.
S � � DIVISION Ready/By:
� T:IG AR D ; Inspection Line: 503.639.4175
Date un Ea See axa 21or
1w'�5 r :mss IInternet: www.[igard or.gov Notified Method, �p, I $epplrment tnformat1a
TYPE OF WORK
❑ New construction ❑ Demolition FEE* SCHEDULE
For special information use checklist
FLAdditionralteration/replacement ❑ Other: Description P 1 Q. 1 Ea. 1 Total
CATEGORY OF' CONSTRUCTION New I- 2- family dwellings (includes 190 ft. for each utility connection)
+- and 2- family dwelling SFR (I) bath 312.70
-
❑ Commercial/industrial
SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family
SFR (3) bath 500.32
❑ Master builder ❑ Other: Each additional bath/kitchen 25.02
JOB SITE INFORMATION AND LOCATION Fire sprinkler ( sc. ft.) Paee 2
Job site address: /t79 7 C_ i ( /91J Site utilities:
/� Catch basin or area drain 18.76
` City/State/ZIP: 'f"jG -R7L /,
Drywell, leach line, or trench drain 18.76
Suite /bldg. /apt. no.: Project. name: �' - _ Footing drain (no. linear ft.: ) Pau 2
Cross street/directions to job site: 6tAtal-jetcf1- Manufactured home utilities 50.03
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear R.: ) Page 2 _
Tax map /parcel no.: Fixture or Item:
DESCRLPTION OF WORK Backflow preventer 31.27
+ Backwater valve 12.51
b r /. /:- . i 1►, '14=1-- Clothes washer 25.02
AD L) *4- 'I1LL) €2 6 ■ Dishwasher 25.02
Drinking fountain 25.02
❑ PROPERTY OWNER 1 ❑ TENANT Ejectors /sump 25.02
Name: Expansion tank 12.51
Address: Fixture /sewer cap 25.02
Floor drain'tloor sink/hub 25.02
City /State /ZIP:
Garbage disposal 25,02
Phone: ( ) Fax: ( ) Hose bib 25.02
❑ APPLICANT . ❑ CONTACT PERSON lee maker 12.51
Business name: Interceptor/grease trap 25.02
Medical gas (value: $ ) Page 2
Contact name:
Primer 12 -51
Address: Roof drain (commercial) 12.51
City/State /ZIP: Sink/basin/lavatory f 25.02
Phone: ( ) Fax : ( ) Solar units (potable water) 62.54
E-mail: Tub/shower/shower pan 1 12.51
Urinal I 25.02
CONTRACTOR
Water closet 25.02
Business name: ni F t? f� p ,4G� Water heater 37.52
Address: cl/ y (p „v. ! ,4 1 f � 1 �- Water piping/DWV 56.29
City /State/ZIIP:ro -n 7' -1,-99 ell_ I• / Other: 25.02
Phone: (, Z5))) " 2_ - al cj - 7, Fax: (p3 ) U _ay a w subtotal
Minimum permit fee. $72.50 72
CCB Lic.: 546 S- Plumbing Lic. no.: 26 2-3 e:C3
Plan review (25% of permit fee)
Authorized signature: 6 / t J S surcharge (12% of permit fee) . 1!
Print name: Atrtp Date: 6 - ��J TOTAL PERMIT FEE f�/ z�,
AlMj
1 lauitdingsPermits�PLMU- Perri :p.doc ixoif09 440-3616T(10 /02'COM/wEU)
Z 17090 88Z - 009 ONIBWfI1d d '8 0 dOE:ZI, 0 L 80 unr