Permit CITY OF TIGARD PLUMBING PERMIT
a - COMMUNITY DEVELOPMENT Permit #: PLM2013 00027
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2013
Parcel: 1 S 134BD06700
Jurisdiction: Tigard
Site address: 11655 SW SPRINGWOOD DR
Project: Anderson Subdivision: ENGLEWOOD NO.2 Lot: 155 , 1
Project Description: (1) branch circuit for bathroom remodel
Contractor: ARTISAN PLUMBING Owner: ANDERSON, MONIQUE
. 315 E SHERMAN ST 11655 SW SPRINGWOOD DR
NEWBERG, OR 97132 TIGARD, OR 97223
I
PHONE: 503 - 484 -7735 PHONE: 703-629-4166 �
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 01/17/2013 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 01/17/2013 $12.51
1 ea Water Closet 01/17/2013 $25.02
Type of Use: SF 1 12% State Surcharge - 01/17/2013 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 01/17/2013 $9.95
Occupancy Grp: Plumbing
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 que .: - C by calling 503.232.1987 or 1.800.332.2344.
Issued B : k e / 6j Permittee Signature: n .
OlL al I .11
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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Jan 1713 04:57p Nap's Thriftway 5035385514 p.1
Plumbing Permit ApplicatipECi1
Building Fixtures �1��11��,. 1!
City of Tigard JAN 17 2013 < 17 l 5 t Perm N°.: a L e d3 -odo
1 11 gi • 13125 SW Hall Blvd.. Tigard, OR 97223 Plan Review
Phone: 503 .718.2439 Faxc 503arroF'I'IGAItD D /By: Other ?militia.:
Inspection Line: 503.639.4175 Dar Ready/By. Jars 21 Sec Pa for
T1i ^x � Internet: www.tigard BUILDING DIVISION Notificd/Method: Supplemental Information
TYPE OF WORK FEE° SCHEDULE
❑ New construction ❑ Demolition For sped a! infornswion use cljeeklisa
_ Description I Qty. I Ea. I Total
Addition /alteration /replacement ❑ Other. New l- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
cilt I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family Each additional bathllotchen 25.02
❑ Master builder i ❑ Other Fire sprinkler ( sq. ft.) i I Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: l 1,.., SS 5 j r( t," p E? • Dryw basin or area drain 18.76
T Drywell, leach line, or trench drain 18.76
City, /State/ZIP: `( I / • , id .- I. ) Footing drain (no. linear ft.: ) Page 2
Suitc/bidgJapt. no.: J Project name: Manufactured some utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18,76
Sanitary sewer (no. linear ft.: ____) Page 2
Stone 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
n- Clothes washer 25.02
(3 A,`Ttf 1- �-'t^"T l Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
a PROPERTY OWNER • ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap j 25.02
Q ►' t J e` Floor drain/floor sink/hub 25.02
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Address: Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: (7t.4) b 2 _,- 4 ,,_ 1, (96 Fax: ( ) Ice maker 12.51
Q. APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) l 12.51
Address:
Sink/basin/lavatory l 25.02 h
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub/shower /shower pan / 12.51 It
E -mail: Urinal 25.02
Water closet / 25.02 k
CONTRACTOR
Water beater 37.52
Business name: A e. -c- 5AiJ PkL' ,A,L3:i,k, t. LC WaterpipmgfDWV 56.29
Address: ? 1 5 r---) 51.,-r vv .51 . Other. 25.02
City /State/ZIP: Iv e-4-% 'v.r •• 0 Subtotal
Phone: ( 573) c .em .- --)7, Minimum permit fee: $72.50 -742 , 50
�. 5 Fax: ( ) P
I s- Z �i i i Ad, g 310 `t >fit, Plan t>rr iew (25% of permit fee)
CCB Lic. Plumbing L ic . no. I
Statcsutcharge(12 %of permit fee) g.
Authorized signature: 7 i y TOTAL PERMIT FEE
al rirr )� 1 / / This permit application expires ifa permit is not obtained within ISO days 7 Prim Rame: C (e .L'�S �Le ` /� after it hiss been accepted as complete '� f
•Fee methodology net by TrbCounty Building Industry 500ice Board. D
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