Permit , CITY OF TIGARD PLUMBING PERMIT
11 1 : = COMMUNITY DEVELOPM Permit #: PLM2012 -00110
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2012
Parcel: 1 S134CB06900
Jurisdiction: Tigard
Site address: 12455 SW NORTH DAKOTA ST
Project: Breaux Subdivision: ANTON PARK Lot: 31
Project Description: New shower pan and drain.
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Contractor: VENNE PLUMBING LLC Owner: BREAUX, GRACE
17678 SW GALEWOOD DR 12455 SW NORTH DAKOTA ST
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503 - 624 -9309 PHONE:
FAX: 503 - 684 -0940
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 05/09/2012 $12.51
Specifics: 1 12% State Surcharge - 05/09/2012 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment - 05/09/2012 $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: I/ by - I / Permlttee Signature:
efi°L /e4 -r7,9"
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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.
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Mai 07 12 02:53p Venne Plumbing 503 684 0940 p.1
Plumbing Permit Application
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Building Fixtures RECEIVED fOli r I. I •I: ONI
City of Tigard Ra t r I B : sO n'm �L,ya
III 13125 SW Hall Blvd., Tigard, OR 7223/ - 8 7 r. 7 a n R Pemnit No.: 0/42 •
Phone: 503.718.2439 Fax: 503.58.1960 Plan
Inspection Line: 503.639.4175 Date/Ely: Other Permit No.:
CITY OF TIGARD Date Ready/By: ® See
Internet: www.tigardor.gov Noti6ed/Mearod:
TYPE �1 >>II<ING DIVISION seDDk Paso mea tal 2 for loformatioo
FEE* SCHEDULE
❑ New construction ❑ Demolition For
special information use checklist
Addition/alteration/replacement ❑Other New Description amil dwcflt I Qty. I Ea Total
y dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job sitc address: 12455 SW North Dakota Catch basin or area drain - 18.76
City/State/ZIP: Tigard, OR Drywell, leach line, or trench drain 18,76
Suite/bldg./apt. no.: I Project name: _Footing drain (no. linear R: _) Page 2
Manufactured home utilities 50.03
Cross street/directions 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: I Lot no.:
Fixture or item:
Tax map/parcel no.: Baddlow preventer I 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New shower pan and drain Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02 -
® PROPERTY OWNER I ❑ TENANT Expansion tank J 12.51
Name: Grace Breaux Fixture/sewer cap 25.02
Address: 12455 SW Breaux Floor drain floor sink/hub 25.02
City/ State/ZIP: Tigard, OR Garbage disposal 25.02
Phone: ( ) Hose bib r 25.02
I Fax ( ) Ice maker 1 1
® APPLICANT 12.51
Q�CONTACT PERSON Interceptor /grease trap 25.02
Business name: Venue Plumbing, LLC Medical as (value: $ _ ) Page 2
Contact name: Ryan Venue Primer 12.51
Address: 17678 SW Galewood Roof drain (commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP: Sherwood, OR Solar units (potable water) 62.541
Phone: ( ) I Fax: : ( ) Tub/shower /shower pan 12.51 ; f, • </
E -mail: - Urinal 25.02
CONTRACTOR Water closet 25.02
Business name: Venue Plumbing, LLC Water heater 37.52
Water piping/DWV 56.29
Address: 17678 SW Galewood Drive
Other l l 25.02
City/ State/ZIP: Sherwood, OR 97140 Subtotal �7
.41/ Phone: (503) 6249309 Fax: (503) 6840940 Minimum permit fee: $72.50 7 L, <!/
CCB Lic.: 192494 Plumbing Lic. no.: PB5936 V Plan review (25% of permit fee)
Authorized signature:
t State surcharge (12% of permit fee)
TOTAL PERMIT FEE ,^
I Print name: Lindsay Venue This f.[_
Dat e: 5/7/12 permit application expires if a permit b not obtained within 180 ad� ys
after it bas been accepted as complete.
*Fee methodology set by TriCamty Building Industry Service Board.