Permit CITY OF TIGARD PLUMBING PERMIT
3 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00075
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/04/2012
Parcel: 2S104BA10600
Jurisdiction: Tigard
Site address: 13665 SW LIDEN DR
Project: LUU Subdivision: CASTLE HILL NO.3 Lot: 136
Project Description: Removing fiberglass shower and installing tile in shower.
Contractor: BRUNER PLUMBING Owner: LUU, MARK &
PO BOX 23985 CHAU, TU
TIGARD, OR 97281 13665 SW LIDEN DR
PORTLAND, OR 97223
PHONE: 503 -484 -5105 PHONE:
FAX: 503 - 624 -2173
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 04/04/2012 $12.51
Specifics: 1 12% State Surcharge - 04/04/2012 $8.70
Plumbing
Type of Use SF 80 ea Minimum Fee Adjustment - 04/04/2012 $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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,0 0 1-- �� Permittee Signature:
Call 39.4175 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.
Plumbing Permit Application
Building Fixtures g� Received •
13125 SW Hall Blvd., Tigar roll OFFICE USE. °NI.Y
City of Tigard c � � A 'L� v Received L /). &3 // StLJ
7 .• Permit No.: , l-/c,))� , 103 ?�
d' .5 23
Phone: 503.639.4171 Fax: 5®3 8.l t Date/By: Plain Review Other Permit No.:
Inspection Line: 503.639.4175 {
P�� Pq0
T I G A R D) NC,, ' e
.. Date Ready/By: �; u�m: fa See Page 2 for
Internet: www. tigard -ongov �� Oc \ Notified/Method: /� Supplemental Information
;. TYPE OF WOR�Z p} ' . FEE* SCHEDULE'
❑ New construction De)S oolition For special information use checklist
Description I Qty. I 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 312.70
[X I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /3 p�� S SC, 1 L/de,kx 7)2 Catch basin or area drain 18.76
City/State/ZIP: / C � _- �at-72_23 Drywell, leach line, or trench drain 18.76
lye I Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Li Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76 '
r . 1 -� Rain drain connector 18.76
( � V 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
• DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
t' ��- + r . -.a MI ...._....t./ _ • . -. /h r � Dishwasher 25.02
�jx,e- S vt-I tnrit-_ Drinking fountain • 25.02
Ejectors /sump 25.02 l
. ❑ PROPERTY OWNER l , ❑ TENANT Expansion tank 12.51
Name:
Fixture /sewer cap 25.02
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 25.02
Business name: Medical gas (value: $ ) • Page 2
Primer 12.51
Contact name: 1
Roof drain (commercial) 12.51
■
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54 •
Phone: ( ) Fax: : ( ) Tub /shower /shower pan at 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
/ 14 Water heater 37.52
in /� e4 ,- Business name: p j j� i i4 Water piping/DWV 56.29
Address: p r L z_3 0785 Other: 25.02
City /State /ZIP: Subtotal
Phone: ) Fax: Minimum permit fee: $72.50 7Z ,
S 3 6Z �� ��)� - zi 73
CCB Lic.: /Y'3 7 Plumbing Lic. no.: 2,6 -v- ri-ig Plan review (25% of permit fee)
State surcharge (12% of permit fee) f?"• 7 J
Authorized si TOTAL PERMIT FEE
. / , Zv
Print name: (/I/ ;!/Y�' .62,/p7.42-7,----
/, / _ _ / Date: V This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I'' BuildinglPermits \PLMU•PermitApp.doc 10/01/09 440- 4616T(10/02KOM/WEB)