Permit CITY OF TIGARD PLUMBING PERMIT
lig a COMMUNITY DEVELOPMENT Permit#: PLM2014-00181
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/05/2014
Parcel: 25111 CD04600
Jurisdiction: Tigard
Site address: 15970 SW BRENTWOOD CT
Project: Gattuccio Subdivision: SUMMERFIELD NO.9 Lot: 505
Project Description: Install new fixtures for(2)bathroom remodels and add laundry tray.
Contractor: ASSURED PLUMBING INC Owner: GATTUCCIO, ROSEANN
PO BOX 230816 15970 SW BRENTWOOD CT
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503-985-9093 PHONE:
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Clothes Washer 06/05/2014 $25.02
Specifics: 1 ea Ice Maker 06/05/2014 $12.51
1 ea Laundry Tray 06/05/2014 $25.02
Type of Use: SF 2 ea Tub/Shower/Shower Pan 06/05/2014 $25.02
Class of Work: ALT 1 ea Water Heater 06/05/2014 $37.52
Type of Const: 1 12%State Surcharge- 06/05/2014 $15.01
Occupancy Grp: Plumbing
Stories:
Total $140.10
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. /J�
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.
Plumbing Permit Application
Building Fixtures RE1'FIFFOlt 01 1 1( 1 1 •l 0\I.1
Received
City of Tigard ON/r, Permit Nop( ,O/1/49/f/
_ . 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Re
Phone: 503.718.2439 Fax: 503.598.1 60 J - 4 2014
Plan Review
Date/By: Other Permit No.:
Inspection Line: 503.639.4175 CITY OF I K ANO Date Ready/By: Ruts ® See Page 2 for
T I V A R D Internet: www.ti ardor. ov 'uf1 /Al- Supplemental Information
g g Notified/Method:
TYPE OF R ,Df NP rgcloP, FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Descri I tion • . Ea. Total
7.: Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
141.,1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I,Can o Sto gcent-woo et C+, Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: ' J[.G(4 L J 9O c1,2224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: , A A,.. 'Ic . 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.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer . ` 25.02
k2 4Ortt,,{tr,M rt0•00ttt1 / Add lAkr,A/'\ 1'o`i , Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
'i,PROPERTY OWNER l ❑ TENANT Expansion tank 12.51
Name: nn y� Fixture/sewer cap 25.02
1'�OSp4�.,�vw, Val lb C4 el i G _I Floor drain/floor sink/hub 25.02
Address: I S-1 r d 5L1 g(c�,T i4mA L�+ Garbage disposal 25.02
City/State/ZIP: ► l3Qm J O 0022A Hose bib 25.02
Phone:( ) J Fax:( ) Ice maker ' ` 12.51
❑ APPLICANT CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: T1 , qq, S Roof drain(commercial) �
�� 12.51
Address: eY Ica(t Sink/basin/lavatory Lifk i..i A,t MEI 25.02
City/State/ZIP: A 6,..:- • 04 ��
Solar units(potable water) 62.54
Phone:t�3 ) lczci•2• bJ . /d Fax::( ) Tub/shower/shower pan 2 12.51
E-mail:TL Ryy- 0 k0(;y cps Urinal 25.02
Water closet 11111 25.02 -
ONTRACTOR
Water heater 37.52
Business name:fatd. 10,v,v.6 gib- , . Water piping/DWV 56.29
Address: •0 ;, • Other: 25.02
City/State/ZIP: Porfla►Nei OR q Subtotal of 2
q 1 Minimum permit fee: $72.50
�
',one:(5 ) (116 ` /0�1?j Fax:( )
p a'a 55- Plan review (25%of permit fee)
CCB Lic.: i ti lI lambing Lic.no.: 1 17 V
State surcharge(12%of permit fee) ,0/
Authorized signature: ///td_- .� TOTAL PERMIT FEE /910./a
Print name: �t,1 (fir-t rfeS Date: fi.H./q This permit application expires if a permit is not obtained within 180 days
� 5`1j
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)