Permit •
IN .! CITY OF TIGARD PLUMBING PERMIT
2. ` COMMUNITY DEVELOPMENT Permit #: PLM2011 -00022
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/20/2011
Parcel: 2S 111 DC 11200
Jurisdiction: Tigard
Site address: 15810 SW OAK MEADOW LN
Project: DeGiavassi Subdivision: Lot: 0
Project Description: Bathroom remodel.
Contractor: 3 MOUNTAINS PLUMBING Owner: DEGIAVASSI, DARCY
PO BOX 230051 15810 SW OAK MEADOW LN
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503 - 670 -1342 PHONE:
FAX: 503 - 670 -9104
FEES
Quantity Description Date Amount
1 ea Sink 01/20/2011 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 01/20/2011 $12.51
1 ea Water Closet 01/20/2011 $25.02
Type of Use: SF 1 12% State Surcharge - 01/20/2011 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 01/20/2011 $9.95
Plumbing
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / Permittee Signature: f/V / 9- 2 el_ 7-70
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
JAN -19 -2011 11:05 From: To : 5035981960 Page:1 /2
Plumbing Permit Applicat,a;
a it
L8� F.IVED
Site Utilities .
FOR OFFICE USE ONO.'
JAN 19 2011
of T leeceircd a
City QA Tigard fle Pennil No. /
• .. Phone: 501639.4171 Date /B : / l / it.� °.4
2/4 �a
• 13125 SW Hall Blvd., OR
., Tigard, �;2T Plan aerie �l �f J /J /r / , y)
���. D Other P ermit NO .- r,CO = 6 1 0 0 1 /
3.639.4171 Fax; 503•;�Q& 1960 /
Inspection Line: 503.639.4175 IOUILUIi'IC DIVISION Dat By
TI ARD P Date Ready /By' lu is &) See Page a for
Internee www,tigard- or.gov Notified/Method: tl7 Supplemental Information
TYPE OF WORK FEE' SCHEDULE
❑ New construction Cf Demolition For special information use checklist.
Descri.tion it . Ea. Total
p4 Addition/alteration/replacement ❑ Other: -
New 1- 2- family dweliini_s (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
and 2- family dwelling ❑Commercial/ ndustrial SFR (2) bath 437.78
Accessory building ❑ Multi- family SFR (3) bath 500.32
_ Each additional bath /kitchen 25.02
❑ Master builder ❑ Other; Fire sprinkler (_ sq. It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities!
Job site address: Catch basin or area drain 18.76
Q as "` PGL� ��
Drywell, leach line, or trench drain 18.76
City /State/ZIP; " c , 0 P.. 9 7 O--Z 3 Footing drain (no, linear li.; 1 Page 2
r
Suite/bldg. /apt. no.: Project name: C\Cric • Manufactured home utilities = 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear It; _) Page 2
Storm sewer (no. linear It; ) Page 2
Water service (no. linear It.: _) Page 2
Subdivision: ' Lot no.: Fixture ur item:
-
Tax map /parcel no.: Backtlow prevemer 31,27
DESCRIPTION OF WORK Backwater valve 12.51
- Clothes washer 25.02
01Q ■, ;n (0 Cta- A.i00 I - Dishwasher 25,02
0 G41-L. Drinking fountain 25.02
Ejectors /sump 25.02 MN
❑ PROPERTY OWNER ❑ TENANT Expansion tank -
Fixture/sewer cap 25.02
Name:
Floor drain /floor sink/hub 25.02
Address: Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax' ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25,07
Medical gas (value $ ) Page 2
Business name: 3 MU,�n -- �(n5 �l �c - v " �ir ,Cv'1 12.51
Primer
Contact name: Co +Z (.-t Inc. l k P QE. 1'T Roof drain (commercial) i2 51
Address; PQ C 4 ' . 3 c..)05( .‘,t ^ Sink/basin/lavatory WM 25.02 •0I--
City/State/ZIP; (7C2(,,kc.rN.3 C) R. 9 7 , i : . - fTS7 - Solar units (potable water) 62.54
Phone; ( S-'3 ) OD 134 a F ax: - ( 2=7-:- ) , Tub /shower/shower pan \ 12.51 1'1.' \
, ) 5 t
E-mail: C4I G.�✓>e p�7e �" lYllii / [ U+** GZ g 0. Water er closet 1 25 25.02 A - p2.
CONTRACTOR 0 ° Water heater .111.E3
Business name: Water piping/DWV 56.29
•
Address: Other: MN 25.02 MEI
Subtotal Mall
City/State/ZIP:
Minimum permit fee: $72.50 .
✓ • 4, •
' ' • ��
one: , • G Plan review (25 permit fee) NMI
y • Ol'AL YLKMI l rut 41 /_0
Authorized signature: � ° r,�
� f This permit appl expires if u permit is nut obtained within 180 days
Print name: C4, � (/2.7 e Date: / 1 r 11 after it has been accepted as complete.
- "Fee melhotiQlotty sot by Tel- County Building Industry Service Board. /