Permit CITY OF TIGARD PLUMBING PERMIT
.... COMMUNITY DEVELOPMENT Permit #: PLM2010 -00358
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2010
T[ G A R D Parcel: 2S104CA02300
Jurisdiction: Tigard
Site address: 13625 SW LAUREN LN
Subdivision: HILLSHIRE Lot: 24
Project: Edwards
Project Description: Replace shower valve and pan.
Owner: FEES
EDWARDS, GREGORY A & LINDA BIRD Quantity Description Date Amount
13625 SW LAUREN LN
PORTLAND, OR 97223 1 ea Tub /Shower /Shower Pan 10/29/2010 $12.51
PHONE: 1 12% State Surcharge - 10/29/2010 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 10/29/2010 $59.99
Contractor: Plumbing
METRO PLUMBING CO
PO BOX 873
NEWBERG, OR 97132
PHONE: 503 - 538 -4094
FAX: 503- 538 -4094
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 No • • • - -ter, Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
or d' t questions to OUNC by - 'ng 503.246.6699 or 1.800.332.2344.
Is ued By: � � !� — /' Permittee Sig ature:
Call 503.639.4175 by 7:00 a.m. for an inspection that busi ss 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.
10/29/2010 08:57 5035887948 BUILDING PAGE 01/
Plumbing Permit A licatio EC EIVED
Building Fixtures FoR orfu-I:: I.'s! ()NIA
City Tigard Da reB : /0 a 9 /o PermitNo.: ,.
S
13125 SW Hall Blvd., Tigard, OR 97223 OCT 2 _ 24 14 p lan Review
_ �l��O�
m . Phone: 503.639.4171 Fax: 503.598.1960 Da,aBy: OF TIGARD other Permit No.:
Inspection Line: 503,639.4175 CITY Y Daie Ready/By: !Iris: ' PJ See Page 2 for
T i r ,11E D Internet www.tigard- or.gov Nadliod/Mctbod: Supplemental Information
ILDI c
': : ,. ... �rvh� ott two � -
0 New construction CI Demolition For special inrormaffon use checklist:
IA- seri,tion •, . Ea. Total
a Addition /aItcrationitcplaeernent ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
-.: eA,#catki torrO.nc°rrow;:::.....: ':. SFR (1) bath
- and 2-family dwelling ❑ G+mmerciaUmtrstrial SPR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- fiunily
Each addithmal bath/kitchen 25.02
o Master builder 0 Other: Fire sprinkler ( s4. fl.) Page 2
TO '.:Si'1`t 1T<TM`f[jfRlr ATil01'ii'A;ND'•Lt/eAtit114 ,.. Site utilities:
/ ' .I Catch basin or arca drain 18.76
Job site addracs
3� Z `� T ywell, leach lint. or trench drain 18.76
City/State/ZIP: °'7; p ilZ '� - 3 +'
�t q r�rd± -/ Z Footing drain (no. linear ft.: , ) Page 2
Suite/bldg. /aptno.: 1 Project. name: Manufactured home utilities 50.03
Cross street/directions to jut, site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
- Storm sewer (nn. linear R.: ,__) Page 2
Water service (no, lincar fL: Page 2
Subdivision: I lot no.: Fixture or item:
Tax map/pared nn.: Backflow prcvclAer 31.27
• . ,... < IitSegiP'I['1+dty OF : :
Clotltcs wa her 25,02
/'tefac.e-_,,5A2(,.Let- ✓_a ev 4.vkti f'4X) Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02 MI
Expansion tank 12.51
PROY�Eit G1'': (�'t NkE` CT AN ' .
Fixture/sewer cap I= 25.
Namc
Gi rod_ _ ed t��dirl Floor drain /floor sink/hub III. 25,02
Address: f 31r2 L „ _ _ Garbage disposal III 25.02
City /Statc/7.TP: (tfitysi 1 T 72 Z 3 Nosc bib 25,02
Phone: ( ) Fax: ( ) ice maker 11 12.51
.. : : : : :I APPLLICJtNT NT .
�.. .:. � � � Tlttcrceptor/ cesc trap 25
t -
medical ( �
A
• M rest gas value: $ ) 2
Business name: m�T i� F7/ f Primer NINE 1 2.5 1
Contact nam } xte s h C e ((- S 3 s3`►..71 t!O_ Roof drain (commercial) 12,51
Address: Po 8 a '_ _ Sink /haain/lavatory 25.02
� City/State/Z1P• � ,, <<., ( p 17 1 v Solar units (potable water) -
Phone: (03 ) s3 8- L( oily r Fax: : ( . 03) ti p} e// Tub /shower /shower pan / 12.51
Urinal 25.02
E -mail: rn /
Water closet 25.02
: a.. : .. :- .....: ... . C'4CTQ[t_. :. Water heater 37.52
Business name: Okb _a/1"m j .,, [ Water piping/DWV 56.29
Address: PO 66 $ 13 v d other: 25.02
City/State/ZIP: - 514ry45 44 - edi- " Ale dg. w Subtotal
mil) 57)5- ,5'3 7- I 0 Fax: (' ) Minimum permit fcc: $72.so 7A kV
Phone: (Cell 1 1114 Plan review (25% of permit fee) '
CCB Lie.: /t5 r 26 (61„iti9 Plumbing Lie. no.: , State surcharge (l2 %of permit fee) S, 7o .
Authorized signature: /0 _ TOTAL PERMIT FEE 8l 2
L _ L Da t e: This permit application expires if a penult is not obtained within 1 days
Print name: ( q+t after it boa been accepted as complete.
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