Permit CITY OF TIGARD PLUMBING PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00364
T'GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012
Parcel: 2S104CD10700
Jurisdiction: Tigard
Site address: 13835 SW HILLSHIRE DR
Project: Cook Subdivision: HILLSHIRE ESTATES NO.2 Lot: 123
Project Description: (1) shower and (1) tub installation
Contractor: A ABOVE ALL JOHN D PLUMBING Owner: COOK, THOMAS L & LINDA G
7472 SW FIR STREET 13835 SW HILLSHIRE DR
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 -620 -7600 PHONE:
FAX: 503 - 598 -9355
FEES
Quantity Description Date Amount
2 ea Tub /Shower /Shower Pan 12/18/2012 $25.02
Specifics: 1 12% State Surcharge - 12/18/2012 $8.70
Plumbing
Type of Use: SF 47 ea Minimum Fee Adjustment - 12/18/2012 $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 OUNCC / /�( by calling 503.232.1987 or 1.800.332.2344. 4 Issued By: r �J7 [//, , // /t Permittee Signature: i d
OJL�VV(( VV ( D 4 P uG4 n v
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.
DEC -17 -2012 07:41R FROM: JOHN D. P 98 -9355 TO:5035981960 P.1
Plumbing Permit Application Vg
B uilding Fixtures DEC 17 2012
City of Tigard Rushed al & /a ' Pencil' NC PL Al 30/0- - W3
., Tigard, SW Ilan Blvdrd. OR 97223 "? Y OF TIGARD pi A r *ha Permit No.:
Phone: 503.6392.171 hoc 503.598 I
Inspection Lune: 503.639.4175 I DKVG DIVISIOPi ma r: 31 s. (, e2 v �.a
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❑ New construction ❑ Demolition Far :pedal hif'""d'" sae
Descnpuon 1 Qty) Ex- 1 Tow
M dition/altcrstionheptaemewt ❑ Other. New I- 2- f■stIly dwellings (includes 100 ft. for each utility connection)
CATEGORY, OR . cordayRUCPLON SFR (1) bMh 312.70
Va I - and 2-family dwelling ❑ Commeit al/ ndustrieI SFR (2) bath 437.1E
Accessory building SFR (3) bib 500.32
❑ A
❑ Multi-family Each additional bathhitdron 25.02
❑ Master builder ❑ Other Fire sprialder (__._ sq. R) 1 Page 2 I
Job we INRORMATmN AND LOCATION Site utilities:
Job site address: 13235 5(A) A-1 (GLS•FP IRE b R. Catch bases "area dry' 12.76
A' Q
City/State/ZlP "C't S 1 - • I l Z23 FOjIt 1, lead( (no. ietre :. _1 drain _ TE -76
Q Footing drain (no. lin ern: Pettis 2
Suite/btdgJapt. no -: I Project name: Mamhctutad frame utilities 50.03
Cross street/directions to job site £(,,9 Ira /af the R . Manholes 15.76
TO crt4 M (S T TOE TO Sto -Fe (1.1.` S-0 ( r2.E Rain drain aartecror 1176
Sanitary sewn (no. lino ft.: ___) Page 2
Stone sewer (no. linear Q: _..) Paw 2
Water service (no. linear It: ____) Page 2
Subdivision: ` Lot no.: visfareorhem:
Tex map/parcel no.: Swallow prevcnma 31.27
• AP,ilCIUYI {ON OP WORK ' Backwater ""1"' 12 51
j L S L 15 Ot Z MJb 1 TV f5 Clotho washer 25.02
t Dishwasher sher 17.02
Drinking fountain 25.02
Ejectors/sun 23.02
PROPERTY OWNI,R I 0 TENANT Expansion lank 12.51
Nano: Fisxardawer 25.02
r^ Roar drainMoor sink/hub 25.02
Address: 1 g 3 5 brag - 11 ( l,. -1,5tf C k. 6 fZ • Garbage disposal 25.02
City/State/ZIP: Ti G k 20 I .0 (2- 1 7 2.Z-3 Hasa bib 25.02
Phone: ( ) Fax: ( ) lee maker 12.51
:4"ATIVCl .. i •�.• 0 CONTACT P*a3OTI irrtercepsor)Pe:aretrap 25.02
Business name: + Medical gm (value: f _., Page 2
COMM Matt: Primer 12.51
Reef drain (cnn ntcrciat) 12.51
Address: Sink/buiaRavrttry 25.04
City/State/ZIP: Solar talc (potable water) 62.54
Phone: ( ) I Fax :: ( ) Tub/shower/Mower pm Z 1251 2S .0 2.:.
--------
E - mail: urinal 25.02
Water closet 25.02
Business name: .j0.14 iJ L.
I . ' -r a I ijQ _ W heater 3162
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Adder i : 7 2, 5 w r ( 5T- Other 2101
City /Staie,7IP: 11 to AR- D ( 0 a - y ✓ %�
4 17-2-23 _ Subtotal
Phone: (: ' 3 @2.0 - `16 0 0 Fay: (103 " 4355 - � Minimum permit fcc: m50 2 . CO
/ Flan review (2514 of penult fee)
CCR LIc.: 53 plumbin t.la nn.: 34 .2 574
AIL State mucilage (1211 of pamft foe) A'. 70
Authorized signature: TOTAL PFRMrT FEE s A I • 'ZQ
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