Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00152
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2012
Parcel: 1S 134BC90004
Jurisdiction: Tigard
Site address: 10945 SW 121ST AVE
Project: Sackett Subdivision: WOODSPRING CONDO Lot: 4
Project Description: Replace tub /shower with shower
Contractor: B AYRES PLUMBING & CONTRACTING INC Owner: SACKETT, DOROTHY L
PO BOX 149 10945 SW 121ST AVE
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -5955 PHONE:
FAX: 503 - 266 -5957
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 06/04/2012 $12.51
Specifics: 1 12% State Surcharge - 06/04/2012 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment - 06/04/2012 $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: Permittee 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.
, 06/ 22:39 5032665955 - TRISTA PAGE 02/02 .54
Plumbing Permit Application ,. r .
Building kilt-urea R E I p ,
g i L I u, ,.l
City of Tigard . JUN 0 4 2 012 a , N
IN __
13125 SW Hall Blvd., Tigard, OR 97223 17atdBy: y �L °� -24 /.2 /5�--
Phone: 503.7182439 Pax 503'59B- 19C%1
T1 OF F r: Other Permit No.:
Inspection Line: 503.639.4175 BUILDING DIUISIO ! °�` B'` Jwir sesPa
Internet waw_tigardor.gov Noueed/Mcdict - �.. Sun+alemmeal1,atorm.sou
❑ New construction ❑ Demolition For 'pedal Wormation use chac@IL9t
'n1 Addition/alteration/replacement ❑ Other. ;Emily dwellings (includes 100 100 I Total
each utilutility a
connection)
C'1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
El Accessory building ID Multi-family SFR (3) bath 500.32
El Master builder kerb additional bath/kitchen 25.02
Other Fire sprinkler (____ sq. ft.) Page 2
Site utilities: -
Job site address: t Qp1 - at prV� Catch basin or area drain
' 18.76 •
Drywall, leach line, or trench drain 18.76
City/State/ZEP: •.'
Suite/bldgJapt.:no.: Project name: S ,, _ •I _
- Footing drain (no. linear R: _) Page 2
�.�G.J[ -� � Manu>bctured firm a txilhles 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear fl.: _j _ Page 2
Storm sewer (oo. linear R: ..._) . 'Page' 2 .
Water service (no. linear It: _) Page 2
Subdivision - J Lot no.: Fixture or Item: -
Tax map /parcel no.: ., Sack flow prevaltar 31.27
Backwatwalve 12.51 •
� �` Clothes washer 25.02
``-t'�4+�� ? vb tno W • Dishwasher 25.02
Drinking fountain _ 25.02
• Ejectors/sump 25.02
Expansion tank 12.51
Name: Fixture/sewer cap ' 25.02
Address Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: - Rose bib 25.02
Phone: ( ) Fax: ( ) Inc maker 1231
r
tale captor /fie trap 23.02
Business name: Medical gas (value: $ ) Page 2
Contact earns: Primer 12 51
Roof drain (commercial) 12:51
Address:
Sink/basidlavatory 25 :02
City/ State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /sbowedshower pan 1 12.51 ia.,
E-mail: Urinal 25.02
25.02
c
-' stet oSet
........... W heatef
ft
star 37.52
Business name: , _ __ _1i `art Water pipiug/DWV 56.29
Address: �11 1 u e _ Other:
l✓ z(C, 1 25.02
- City/3ta>:JZP: Subtotal
Phone: 1 ) , Fax: ( 95 ) `'t�� Minimum permit tee: $72.50 --.41...5
CCB Lie.: Lam "3 R.. Plumbing Lic. no.: r1 1� 3b % Plan review .(7.5% of permit tee) •
A Stare surcharge (12%' o£pan)rit fee)
Authorized siggantre. mh TOTAL PERMIT FEE O f m'4, .
Print pag0.e: Date ..... This permit application as d• mi • ■ pert is not obtained within 150 days
-
-el d
after it bas been accepted se complete.
*Fee methodology set by 7}i-County BuOiling Industry Service Board -
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