Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00053
T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2012
Parcel: 1S 133DD04600
Jurisdiction: Tigard
Site address: 11555 SW SHOREVIEW PL
Project: Provancher Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 85
Project Description: Install (1) tub and (1) shower.
Contractor: EXCELLENCE PLUMBING LLC Owner: PROVANCHER, RICHARD A & ANNETTE
7520 SW 140TH AVE 11555 SW SHOREVIEW PL
BEAVERTON, OR 97008 TIGARD, OR 97223
PHONE: 503 - 643 -3459 PHONE:
FAX: 503 - 643 -2815
FEES
Quantity Description Date Amount
2 ea Tub /Shower /Shower Pan 03/08/2012 $25.02
Specifics: 1 12% State Surcharge - 03/08/2012 $8.70
Plumbing
Type of Use: SF 47 ea Minimum Fee Adjustment - 03/08/2012 $47.48
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 OUNC by calling 503.232.1987 or 1.800.332.2344. --�
Issued By: � �� Permittee Signature: ^J C „ /i
6C/G / � C�
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.
03/08/2012 11:35 FAX [1001
P lumbin e Permit A licatio Ce
t 1 YE I . .
Building. Fixtures I'i'i` (B i` 1 t,1 a 1. i N
MA R 8 2 012 Re aival Peranit
City of Tigard ,na 3 g I Lyae / 2..,5- .
.
_ 13125 SW -I Tall Blvd.; Tigard, OR 9, .y . pF TI G/ l ^ Plan Revfow Otb Permit No..
' Phone: 503.718.2439 Fax: 503.591P • ` ARD Detc y: N - -
Inspection Line: 503 r ):NG DIV)�)p A nte Ready/By: sl see Pa ge 2 rer
i r. i i r Internet www.tigard-or•gov
Notitted/Mahod: r,epperneater Information
TYPE OF WORK - FEE" SC IEDULE
❑ New construction ❑ Demolition For special ir#jo.rrmdo>r use amnia.
Description 1 Qty I Ea I Total
0 Addition/altcrelion/replacement ❑ Other: New 1- 2- Ibmlly dwellings (includes 100 R. for each utility connection) ^
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building 0 Mulct- family r
Each additional bath/kitchen 25.02
❑ Master builder 0 Other: Fire sprinkler (_ _. sq. ft.) - Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: -
Job site address: 11555 SW Shoreview Catch basin or area drain 18.76
Drywall, leach line, or trench drain 18.76
City/State/ZIP: I Igard, OR Footing drain (no. linear ft.: _,_ ..) Page 2
Suite/bldg./apt. no.: J Project name: Provaucher Manufactured home utilities 50.03 -
Cross street/dlreetions to job site: 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: Lot no.: Fixture or item: _
Tax map /parcel no.: Fiackflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
- -- Clothes washer 25.02
Install 1 tub Dishwasher 25.02
Install 1 shower Drinking fountain 25.02
- Ejectors/sump 25.02
0 PROPERTY OWNER J 0 TENANT Expansion tank - 12.51
Nome: Fixture/sewor cap 25.02
- Floor drain/floor sink/hub 25.02 •
Address: Garbage disposal 25.02
City /State/ZIP: Nose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Add: Sink/basin/lavahxy 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) j Fax: : ( ) '1 ub/shower /shower pan 2 12.51 25.02
E -mail: Urinal 25.02
- Water closet 25.02
CONTRACTOR -
Water heater 37.52
• Business name: Excellence Plumbing, LLC Wad piplg/DWV 56.29
Address: 7520 SW 140 Ave Other: 25.02
City /State/ZIP: Beaverton, OR 97008 - • Subtotal 25.02
Phone: (503) 643`3459- Fax: (503) 643 -2815 Minimum permit the: $72.50 72.50
CCII tic.: 175768 . Plumbing Lie; no.; 1D344 Plan review (2596 of permit fa)
Statesutcharge (12.% of permit fee) 8.70
Authorized signature: oo: , , . TOTAL PERMIT FEE 81.20
I Print name: Shelly Eugenio ff I Date: 03108/2012 This permit eppneatian expires if a permit Is not obtained within ISO dqr<
after it has been accepted ss eompkte.
"Fen methodology set by Tai .County Building Industry Service Board , •
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