Permit it
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CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00226
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/17/2009
T f c ; I <:. C7 9 Parcel: 2S102CA00208
Jurisdiction: Tigard
•
Site address: 13255 SW ASH DR
Subdivision: VIEWCREST TERRACE Lot: 6
Project: Westfall
Project Description: 398 square foot addition to rear of home.
Owner: FEES
ANDERSON, LENE H Quantity Description Date Amount
13255 SW ASH DR
•
TIGARD, OR 97223 1 ea Clothes Washer 08/17/2009 $16.60
PHONE. 1 ea Lavatories 08/17/2009 $16 60
2 ea Tub /Shower /Shower Pan 08/17/2009 $33.20
1 ea Water Closet 08/17/2009 $16.60
Contractor: 1 12% State Surcharge - 08/17/2009 $9.96
SILVER MOUNTAIN PLUMBING INC. Plumbing
14735 SW BONANZA CT.
BEAVERTON, OR 97007
PHONE: 503 - 644 -2123
FAX 503- 574 -3252
Type of Use: SF
Class of Work: ADD Type of Const: VB
Occupancy Grp: R -3
Stories:
Total $92.96
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: a / Permittee Signature: AT I)
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.
Aug 1's' 09 08:08a 5035743252 p.2
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE - USE ONLY
c ity o f Tigard y Received
1 _
Received
B I Permit Ne.. ? ).44 200q - OD/6_3
a [ 3125 SW Hall Blvd., Tigard, OR 97223 q
2oO v Plan Review
Phone: 593.639.417 I Fax: 503.598.196t�t)i- 13 D Other Permit No.:
TIGARD
Inspection Line: 503.639.4175 CARD Date Ready /By: knit: RI See Page 2 for
Internet: www.tigard or.gov w ny 1 l /.,, Notified/Method: Supplemental Information
TYPE OF WORK� n‘ NGD ��'t l9 FEE* SCHEDULE
d emolitio n For special information use checklist.
❑ New construction ❑
Description I Qty. 1 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 249.20
Qj 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
0 Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑Oiler: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: j 3 e2 5',,j As' Dr . Catch basin or area drain I 16.60
City /State /ZIP: / j Dr leach line, or trench drain I 16.
alt q � c - �-� t 16.60 ___
Suite/bldg./apt. no.: :pal, Project name:, SCL-I /
Footing drain (no. linear II.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
---"--2:D Manholes 16.60
� Rain drain connector 16.60
A --b--r) 5T O.,h., ^^p (" DO Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no, linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear R.: _ ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve I 16.60
DESCRIPTION OF / WORK Backflow preventer ! Page 2
1 um /i �+ /O /,tL� 1;1 / 11. , Backwater valve 16.60
�J Clothes washer f 16.60 /( , ( c,
Dishwasher 16.60
• Drinking fountain 1 6.60
❑❑ PROPERTY OWNER ❑ TENANT
Ejectors/sump 16.60
Name: • Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
1:1 APPLICANT ❑ CONTACT PERSON Hose bib 6.60
�
., Ice maker 1 6.60
Business name: 3 J. �.�� Ot ,..,..6cc i f1 f} �J i bv-vl I...r - , Iv C. Interceptor /grease trap 16.60
Contact name: P j C.b� 6-r ->it 1 (l' Medical gas (value: $ ) Page 2
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Address: I L.{ -? 3 S Sl.ei _ �� i Primer 1 6.60
City /State/ZIP: 3ecw e „, ' � >, c (O 7 Roof drain (commercial) 1 6.60 -
��) F ax:: ( 7j) Sink/basin/lavatory 1 16.60 /( , (P 0
Phone: (
�lP� -yS �t-t S'� -3 a Tub /shower /shower pan 16.60 33 -ao
E- mail: 5; iver col I r k },C ) u /1-tb; r)-1s n, CArn Urinal 16.60 •
CONTRACTOR Water closet t 16.60 / (a, (PO
Business name: �^ ^ Water heater
10 uSlG ; (‘Q _, r)--,l` a __ - 16.60 G. GO
Address: Ll - J Other:
City /State /ZIP: �tt2k C l70 7 Subtotal �, pC
- Minimum permit fee: $72.50
Phone: ( 5 3 S) toLf - al D-3 Fax: (5b3) 5 -3 D-s a-- i4' Residential backflowminimum permit fee: $36.25
CCB Lie.: ) 5 .7 ( / pull(/ Plumbing Lie, nu.: 3L{, Li a� po Plan review (25% of permit fe
II
Authorized signature: State surcharge To (12fA% of Pti permit uT feeFfiE ) !:99 (A �/ � /) t vp'i ' 7- � e �/.�/�� ! (r.Rlv 9 � 1
Print name: /✓ hY'„1 Go / ( I Date: 3- ) 3/ (--)(3 This permit application expires if a permit is not obtained within
ISO days after it has been accepted as complete.
*Fee methodology set by Td-County Building Industry Service Board.