Permit CITY OF TIGARD PLUMBING PERMIT
111111 2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00381
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2011
Parcel: 2S 102CA00204
Jurisdiction: Tigard
Site address: 13295 SW ASH DR
Project: ROBERTS Subdivision: VIEWCREST TERRACE Lot: 2
Project Description: Drain for tile shower.
Contractor: THE PLUMBERS INC. Owner: ROBERTS, DUWAYNE H
15808 SW UPPER BOONES FERRY RD BONNIE B
LAKE OSWEGO, OR 97035 13295 SW ASH DRIVE
TIGARD, OR 97223
PHONE: 503 - 519 -6644 PHONE:
FAX: 503 - 684 -1202
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 12/27/2011 $12.51
Specifics:, 1 12% State Surcharge - 12/27/2011 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 12/27/2011 $59.99
Plumbing
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 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 NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: •
— Perm ittee Signature:
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.
Dec 27 2011 8:40RM The Plumbers Inc. 5034694540 p.1
Plumbing Permit Application 4 ��
Building Fixtures G �� FOR 4)F4 I( I I: 1INI
of Received p ermit No.: /
City SW Hall and �� . ,ti -JOL./
Date/13 ': 1 7 rai _L
• 13125 SW Hall Blvd., Tigard, O .� ��' S_ plan Review Other Permit No.
e Phone: 503.718.2439 Fax: 503.5 8.1960;. G1' .4� Date
TI ,_ Ins Line: 503.639.4175 0 ��� Noti R� � ood: 1' � t � m eee �
\ ®See for
' '^ ! � � Intem�: www tigard - o[ gov Sa t le atal lntormatioo
\ w 4 fi3 j! " 3t?1 &4n ,r r q J.i t } "` �'. i{ a . r! i *
? *.tf 1 i ? lie TI
'' ilel 11+ r„ 4� ,�y F?"77 ` p ^ 'Fi " t '' F�;y l « 4*: r _4 'h3; r 'fit. +�� . I i , 1.2 . 4
��i' l '...&'IlS'tF stl.� l., i
. $31 ( s ,d `diti1th '� : id, r .. -. , , 'y 9i:ia'. �r1?:' a@G: . a....1. l :E ,l . c U.�
° For special information use checklist.
❑ New construction 1:1 DemA'�ton Description I Qty. I Ea. I Total
r 4 Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 fl. for each utility connection)
`4 i
"'ce iz � � t 1 ., lri9 ?1, a t � y e 7 • 1 1 . ' " *k ; ' r SFR (1) bath 3 12.70
�a '. � � iisi ugysc r rt 3s; wr i:lan4 - - 1 ..si 4 ..., �l SFR (2) bath 437.78
.1 1- and 2- family dwelling ❑ Commercial /industrial
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other Fire sprinkler ( sq. ft.) Page 2
ra* n: 3 tt � s4 a i tt..,; u, 'w r- � }{� '" , ` " Site uti
' " . i- 1P �. usre +� lw uur :+'b !! n iti u an ... a .. i!t. *-
q C' , ` Q � Catch basin or trot drain 18.76
Job site address: Z sw 1 2 Drywell, leach line, or trench drain 18.76
City /State/ZIP: "\ 1 p , bR qr 'Z 3 Footing drain (no. linear ft -: �) Page 2
Suite/bldg./apt. no.: J I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
- Rain drain connector 18.76
Sanitary sewer (no. linear It : ) Page 2
Storm sewer (no. linear ft: __J Page 2
Water service (no. linear ft.: Page'2
Subdivision: l Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map /parcel no
f,iIr u, u , a ir i _ . r " r� 1y1 Backwater valve
15
q Iraik. ?Or � e� arkdi . `dil ( 61 . yr� Clothes washer 25.02
l it '4'�k.> 1• Lt gr`��-,IS- Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
s II +jf A` � arm ns �• � * t i -+ . ' . _' Expansion tank 12.51
.:4 ta:ii a?al4iAla i ):�...buV .�.., � k. a }
' m '._.._� uu, .. 1 FixtureJsewercap 25.02
Name: U W l' E. t' �? )fl - D g C �' S
� Fioor drain/floor sinkThub 25.02
Address: l 3 a 1 t- 'S () pt5h fc7yr Garbage disposal _ 25.02
City/State/ZIP: T110\-0.rici 1 C)g., ar122.3 Hose bib 25.02
Phone (5 05) C4 (0$,3 Fax ( ) Ice maker 12.51
IU 4 �u * r ax ?'��1; ' _ x t a i
d�" st ads IF i r.�e t; i.
r t !, Tn teroeptorrgrease trap 25.02
iiiliL �"1 i 1 - .�,.; iald ., -Au v t fd . � � r1; ASk, .ltu 'fi ' .. 4 a. : Medical gas (value: $ ) Page 2
Business name: �h� P t_skyy\ 1 ( .. 12.51
( � ` Primer
Contact name: l u 11.Q_IA . \AawYwY10 S Roof drain (commercial) 12.51
Address: C 3 Kim t 5O A.vQ. Sink/basin'lavatory 25.02
City/ State/ZIP: - tj i - 4oy - a q `V) ( Solar units (potable water) 62.54
t (j Lo 10 I L l2O z Tub /shower /shower pan I 12.51
Phone: („c03) S j q -(1(.(2 t{ 14 l Fax:: ) U'_ , [
p Urinal 25.02
E mail uCk„ ) - P _1 , SthL, L!. 25.02
r• "� T4 x , t t3 'ri 'fl z r sy � f ' l �'-r - r1 #'3'l "�,. " fi S llr t a r� a W ater closet
,lA r ` Isl w3- i` D y li w
i ¢ �rt4i�,.,. 'dlitfrt,..(aaiis .;;s ue Water heater 37.52
Business name: 'TyQ P 1 'S Ch C.. , Water piping/DWV 56.29
Address: a) t,10 V C )' Apt? . der: 25.02
City/ State/ZIP: (t Ji r+-py 0 q 1 0o 0 Subtotal
1 Minimum permit fee: $72.50 7,2 , ,r
Phone: 3) SL cl _LetoLi Fax: (S03) (A V t 2b z
�
, I Plan review (25% of permit fee) ,
CCB Lic.: 1/ 9'�� Pltmmbing Lic. no.: "7 Stale surcharge (12% ofpennit fee) e « 10
Authorized signature: TOTAL PERMIT FEE f , 9,C;
�� Date: p 1 This permit application expires if a permit is not obtained within 180 days
1 Print name:C I�s�jm nits Z� i after it Ins been accepted as complete"
�� •Fee methodology set by Tri- County Building Industry Service Board.
BBui !ding'PcrmilslPLMU- PnmitApp.doc 10,01/09 440 -4616T(10 /02(COM/WEB)