Permit q CITY OF TIGARD PLUMBING PERMIT
11111 8 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00044
T f G AR L3 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/08/2011
Parcel: 2S103DB05100
Jurisdiction: Tigard
Site address: 11175 SW NOVARE PL
Project: STREICHER Subdivision: GENESIS NO. 2 Lot: 48
Project Description: Bathroom remodel.
Contractor: BANK PLUMBING & CONTRACTING INC Owner: STREICHER, MICHAEL R & PEGGY A
PO BOX 149 11175 SW NOVARE PL
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -5955 PHONE:
FAX: 503 -266 -5957
FEES
Quantity Description Date Amount
1 ea Sink 02/08/2011 $25.02
Specifics: 2 ea Tub /Shower /Shower Pan 02/08/2011 $25.02
1 12% State Surcharge - 02/08/2011 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment - 02/08/2011 $22.46
Plumbing
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 -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: /", rmittee Signature:
Call 51 . • 75 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.
02/09/2009 23:06 5032665955 TRISTA PAGE 01/02
Plumbing Permit Application
Building Fixtulres 1'()It (), I- I( I. SL c1\LN 1 )
City of Tigard L 1 NAPPII Permit No.:
IN
q 13125 SW Hall Blvd., Tigard, OR 97223 � , � \\ n Review Received
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Plan
I ' Phone: 503,639,4171 Fax: 503.59V960 ;� � pate Other Permit No.:
Inspection Line: 503.639.4175 �' t pats Ready /Uy: r See Page z for
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❑ New construction Et Demolition Fora edal I srm triton use checklist
Description Ea.
176ddition/alteration/repiacement El Other: New 1 2 family dwellings (includes 100 ft. for each utility connection)
Q i, r, 7 �3'!I} t N�'� t eN%t'l t N r'4alt l L.4!i N ' ', it N 5 i Gk Ii} i k � ;; r i r J � r i ` } E, 1 n o ui y si , `F' }i( i M 1 , Fl r ��t , r SFR ( I) bath 312.70
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M. - 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
f T f e e ,y � S 77'ITrrryr^,7i t ' 1 I s fl l f' . .i G i ° i c y . t I l { J i } ! Site utilities:
..-rz. }g ._ � ,,'wi-,1,. .,4 J .F4,1+1,a•cc;.uM.rknauci l rLtidJ `II?J '»,its : ri is, tit.: + v
Job site address: , 1 n 5 c,, n t�V 0� P` ct" Catch basin or area drain [ 8.76
ra L Drywell, leach line, or trench drain 19.76
I City /State /ZiP: OR, -
t Q ` , v,1 aa.. Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: Project name: C �� �� r dne Manufactured home utilities 50.03
Cross street/directions to job site: �� JJy, � 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
Mi. n a , r., �, n ackwater valve 12.51
i i1 1� ,i }} ,,��,, 0 }¢ egqlpppp��l 4�' S
11 E ' °,� #�� �B�E 1 r i .: + , .�� I a ^ ( , ° 9 �' I'€ � �. Clothes washer 25.02
�f� �Ni � k1' � N,>1� a s 5„ .�. r'at ,n + t� niYPJ, j - -„��.w ani:�T%
C�'�� t e"� ` $ • be m Dishwasher - 25.02
Drinking fountain 25,02
Ejectors/sump 25.02
ili 11 N' N1sperta t r r r 1N y t' ^ r 1 E if r e} Sa'l!!t( L� NN =
„ 5 L jpr i i ,:r Nq " 1d11�b' r ;� � rr i e r tr lfRSilf(1 iIJi �y 4 S,4{ , n' ,, Ex tank 12.51
, l sr >lttitL�:lti� � .. � s. w ��'>i � � : !y
Name: Fixture/sewer cap 25.02
Address: Floor drain /floor sink/hub 25.02
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
r F ti iNlN kr j N ) I t ! " 1 # , tl't N1( {, Ir o N r t❑ r ilt r a r
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;.J fir,.. si i I� , t;' w is : , ' i `sAii4 '?,!' h. U �1 • Ni ,3 .,1'. 1 , ,d w l iilalli} � , 1 •
. InterCCptor /groase trap 25.02
Business name: lb Medical gas (value: $ ) Page 2
f 1 L�6`iti�1 � Primer 12.51
Contact name. f a p er
Roof drain (commercial) 12.51
Address: t Sink/basin/lavatory 25.02 , 5. Oa
City/State/ZIP: ( Solar units (potable water ��
(� r� 0713 cp ) _.`a . .al ..
Phone: ( a] aut Fes:: (�� Tub /shower /shower pan 12.51 `A t �� Urinal 25.02
E-mail:
YJi �• \1?(r*1t 1 • -
pn vu1 , r r ,� i�`P'{`N`° i1�i'�:nNM l ; i 4 t p.t , Water closet 25.02
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.. :... .......i ' .u..m:: :., f i,tl 3 a l $ .w.. , -1. i 1. { � �lii water heater 37.52
Business name: I-lk ` • m ii .• Water piping/WV 56.29
Address; �
�( �1 1 Other: 25.02
City /State /ZIP: <"ia l QICK Subtotal
Phone: >) attp aq 5J Fax: 65 ) 2 -.7 ,57.7 „, � Minimum permit fee; $72.50 7), r
CCB L,ic.: 1- '�'7 -,�+ � I /(, ( 3 Plumbing Lic. no..: \ 7/ / / r Plan review ( of permit fee)
�
/ , f State surchar (112 /e of permit fee) , "7p
�1 �.
Authorized signet `. TOTAL PERMIT FEE F ,
Print name: �j' t - e Date: ( This permit application expires if a perniif is not obtained within 180 days
�3 L after It has been accepted as complete.
11 -Fee methodology set by Tri- County Bu91din5Industry Service Board.
1: 1Building \Permits\PLMU- PermitApp.doc 10/01/09 440.461dT(1W02/COM/WEa)