Permit CITY OF TIGARD PLUMBING PERMIT
o COMMUNITY DEVELOPMENT Permit #: PLM2010 -00299
T (G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 2S104CB04000
Jurisdiction: Tigard
Site address: 13324 SW ASCENSION DR
Subdivision: HILLSHIRE WOODS Lot: 86
Project: Mills
Project Description: Bathroom remodel, (2) lays, (2) showers & (1) water closet.
Owner: FEES
MILLS, ALAN J & CATHLEEN A Quantity Description Date Amount
13324 SW ASCENSION DR
TIGARD, OR 97223 2 ea Lavatories 09/14/2010 $50.04
2 ea Tub /Shower /Shower Pan 09/14/2010 $25.02
PHONE: 503 - 350 -2117 1 ea Water Closet 09/14/2010 $25.02
1 12% State Surcharge - 09/14/2010 $12.01
Contractor: Plumbing
FIVE STAR PLUMBING LLC
6138 SE 136TH AVE
PORTLAND, OR 97236
PHONE: 503 - 987 -5000
FAX:
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 - • • ork will be done in accordance with approved plans. This permit will expire if work is not started wit n 180 days of
issua • e, or if work is su • - ded for more the 180 days. ATTENTION: Oregon law requires you to follow t •e rules ado. d by the Oregon
Util' Notification Center. Tho - rules a - et forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. Y•I ay • .tain : copy of the rules
or .irect questions to OUNC by c• lin. 03.246.6699 or 1.800.332.2344.
Is ed By: �..- A � Permittee Signature: r
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 Application
Building Fixtures RECEIVED R eceived
City of Tigard Permit No
V 131 SW 13125 Blvd., Tigard, OR 972p 1 2010 O , O Plan /By: Review
4 Pla / / O l-d7' polo-04W?
C • Phone: 503.639.4171 Fax: 503.598.1960 n Date /By: Other permit No.:
Inspection Line: 503.639g g ardor. .4175 CITY OF TIGARD Date Read /B Juris: H See Page 2 for
" � l D Internet: www.ti ov Notified/Method: o
d: Supplemental lnformation
TYPE OF
• • mug g f • 1 FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
0 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other. Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13324 SW Ascension Dr. Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: Tigard, OR 97223
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Mills Bath Remodel Manufactured 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
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
replace existing tub with new corner tub
Dishwasher 25.02
replace shower valve Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Kathy and Alan Mills Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13324 SW Ascension Dr
Garbage disposal 25.02
City/State /ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: (503)350 -2117 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: MS Construction & Remodeling, LLC Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Nick Marcu
Roof drain (commercial) 12.51
Address: 9570 SW 80 Ave Sink/basin/lavatory 2 25.02 ,!jPq
City/State/ZIP: Tigard, OR 97223 Solar units (potable water) 62.54
Phone: (503) 939 -6420 Fax: : (503) 245 -7167 Tub /sho r /sho pan 2 12.51 'p5.
E -mail: nmarcu @hotmail.com Urinal 25.02
CONTRACTOR Water closet ' 25.02 a5 09,
Water heater 37.52
Business name: Five Star Plumbing Water piping/DWV 56.29
Address: 6138 SE 136 Ave Other: 25.02
City /State /ZIP: Portland, OR 97236 Subtotal //i9,0 •
Phone: (503) 997 -5000 Fax: (503) 762 -5795 Minimum permit fee: $72.50 -'-'
CCB Lic.: 176756 Plumbing Lic. no.: PB370 Plan review (25% of permit fee) --e
State surcharge (12% of permit fee) 1 Ai
Authorized signature: 0 TOTAL PERMIT FEE ,/ f a. el
Print name: Cornet Curea Date: 09.13.2010 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440.4616T(10/02/COM/WEB)