Permit •
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o' CITY OF TIGARD PLUMBING PERMIT
'COMMUNITY DEVELOPMENT Permit #: PLM2012 -00342
T [GA RD 13125 SW Hall Blvd., Tigard OR 97223 503:718.2439 Date Issued: 11/21/2012
Parcel: 1 S 133CD16100
Jurisdiction: Tigard
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Site address: 11593 SW WOOD DUCK PL
Project: Madden Subdivision: PEBBLECREEK NO.3 Lot: 51
Project Description: (1) shower drain & vent for new tile shower
Contractor: THE PLUMBERS INC. Owner: MADDEN, SALLY
90 NW 150TH AVE 11593 SW WOOD DUCK PL •
BEAVERTON, OR 97006 TIGARD, OR 97223
PHONE: 503 - 519 -6644 PHONE: 503 -519 -6644
FAX: 503 - 684 -1202
FEES •
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 11/21/2012 $12.51
Specific s: 1 12% State Surcharge - - 11/21/2012 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 11/21/2012 $59.99
Class of Work: ALT
Plumbing
Type of Const:
Occupancy Grp:
Stories:
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• 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.
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Issued By: \�,� I „ ♦ Permittee Signature: 0*4 APPUclera 00
+y �Caallll 5� ( 033..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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Nov .21 11:02 AM The butotivED 503 684 1202 PAGE. 1/ 2
Plumbarle Permit Application
Building Fixtures NOV 21 201 ,, (1H:I(,. I NI. IFNI 1
City of Tigard CITY OF TIG ' ls 1 ' 6 COi"0d Permit No .:L.t1 D 11- 3--
1111 II • Phone: 03.718JA 9 Tigard, F ax: 503.598 1 DIVISI 1 Ra iew /e �-t / a- S fi P e�3 ' T'
r _ , _ Other Permit No.:
i , `.` i Inspection Line: 503.639.4175 Duo Ready/By, ti* I y Page 2 for
■ . Internet: www.tigard- or.gov Notified/Method: - I tY Sup pkmun ml lnformadoo
TYPE OF WORK . PEE" SCHEDULE
❑ New construction ❑ Demolition For epecial irl/ormagion use checklist.
Description ( Qty. I Ea. I Total
® Addilion/ultcrution/rcplacomcnt ❑ Other. New 1- 2 -family dwellings (includes 100 R. for each utility connection)
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CATEGORY OF CONSTRUCTION • • SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /i SFR (2) bath 437.78
SFR (3) bath 500,32
❑ Accessory building ❑ Multi- thmily
Each additional bath/kitchen 25,02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
. JOB SITE INFORMATION AND LOCATION Slte udlldes:
Job site address: 11593 SW Wood Duck PI Catch basin or area drain 18.76
Drywcll, leach line, or trench drain 18.76
City /StateIllP: Tigard, OR 97223 Footing drain (no. linear ft.: _) Page 2
Suite/bldg./apt. no.: I Project name: Manufactured home utilities 50.03
Caws street/directions to job site: Manhole 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 nu.: Fixture or item:
Tax map /parcel no.: Back low preventer 31.27
. DESCRIPTION OF. WORK Backwater valve 12.51
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Clothes washer 25.02
Install mud set shower drain & valve for new tine shower Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY. OWNER .. . I .: 0,. TENANT . . Expansion tank 12.51
Name: Sally Madden Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11593 SW Wood Duck Pi
Garbage disposal 25,02
City/State/ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: (503)524-7681 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: The Plumbers Inc. Medic al gas (value: $ _ ) Page 2
Primer 12.51
Contact name: Judah Hennes
Roof drain (commercial) 12.51
Address: 90 NW 1.50 Ave. Sink/basin/lavatory 25.02
City/State/ZIP: Beaverton, OR 97006 Solar units (potable water) 62.54
Phone: (503) 519 -6644 I Pax :: (503) 684 -1202 Tub/shower /shower pan 1 12.51 12.51
E -mail: judah@theplumbcrsinc.net Urinal 25.02
Water closet 25.02
. • CONTRACTOR •
• Water heater 37.52
Business name: The Plumbers inc. Water piping/DWV 56.29
Address: Other: 25.02
City /State/ZIP: Subtotal
Phone: (.So3) SID{ --Q.t eN permit ( ) Minimum peit fbe: $72.50 72,50
CCI3 Lic.: 177214 Plumbing Lic. no.: P11447
Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
AullxNixexl signulurc: �`11M, 'rO'1'AL PERMIT FEE 81 20
Print name: Judah A Date: 11/21/12 This permit epplkedon expires it a permit Is not obtained within 186 days
after II has heels eecplted as complete.
'Foe methodology set by Tri- County Building Industry Service Board.
LtBuildiop enniti\PLMU•PermitApp.doo two IMO 440.4616T(1N112/e:OW.WEB)