Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2014-00232
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/16/2014
Parcel: 25111 CD06200
Jurisdiction: Tigard
Site address: 9837 SW KIMBERLY DR
Project: Reigle Subdivision: KERWOOD ESTATES Lot: 25
Project Description: Bathroom remodel,install(1)new soaking tub,relocate/replace(2)lays,(1)toilet&(1)shower stall.
Contractor: CANBY PLUMBING Owner: KEN REIGLE
805 NE 4TH AVE 9837 SW KIMBERLY DR
CANBY,OR 97013 TIGARD, OR 97224
PHONE: 503-266-2091 PHONE: 503-569-9432
FAX: 503-266-1424
FEES
Quantity Description Date Amount
2 ea Lavatories 07/16/2014 $50.04
Specifics: 2 ea Tub/Shower/Shower Pan 07/16/2014 $25.02
1 ea Water Closet 07/16/2014 $25.02
Type of Use: SF 1 12%State Surcharge- 07/16/2014 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 •- .in 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.
Plumbing Permit Application
Building Fixtures
City of Tigard 2ECFIhitj Received� y. 'T /a, /y cj.e Permit No.: 14- -OOH 3i-
• 13125 SW Hall Blvd.,Tigard,OR Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 ryaWB : Other Permit No.:
Y
11cn1:t�
Inspection 1.inc 50.3.639.4175 �- Date Ready/By: runs: gi See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
'TYPE OF W01440 V1 ill t [j FEE* SCHEDUI:F,
'''`I 4? ,n F rt eyes
]New construction 0 Dent on 'if For special information use c hecklist
Description I Qty. 1 Ea. I Total
kAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility correction)_
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
_.
1,1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78- SFR(3)bath 500.32 _
]Accessory building 0 Multi-family Each additional bath/kitchen 25.02
]Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND.LOCATION Site utilities:
"" Catch basin or area drain 18.76
rb site address: S'� ,� _t% _ �-
'.-. �j Drywell,leach line,or trends drain 18.76
icy/State/ZIP: j cam/ ..- �. Z24 Footing drain(no.linear It.: ) Page 2 y
uite/bldg./apt.no.: Project name:
Manufactured home utilities 50.03
ross street/directions to job site: Manholes 18.76_.
Rain drain connector 18.76
- Sanitary sewer(no.linear ft.:__) Page 2
- Stotrn sewer(no.linear It.: ) Page 2
__ _ _.•.._ Water service(no.linear ft.:_) Page 2
ubdivision: , Lot no.: Fixture or item: _
Backflow preventer 31.27
ax map/parcel no.:
Backwater valve 12.51
DESCRIPTION OF WORK -
_ Clothes washer 25.02 _
//&.14.4 '- s )1L_ 16: 274-6/ Dishwasher 25.02
5-tJU�L 1S _ J Drinking fountain 25.02
Ejectors/sump 25.02
- Expansion tank 12.51❑ PROPERTY OWNER 1 -- ❑ TENANT
Fixture/sewer cap 25.02
lame: s __ Floor drain/floor sink hub 25.02
tddress: gsi,3' -„• %{nj" , Garbage disposal 25.02
'ity/State/ZIP: l7 4 (f 2 Z_,, ' �..._ Hose bib 25.02
'hone::3) ., Z Fax:( ) _ Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:S ) Page 2
tusiness name: M•+gt ,j1JL'L" a - Printer 12.51 •�
'ontact name: 1s`/)0 iL /S (�j IA_
_ Roof drain(commercial) 12.51
\ddress: /3 $ W., ` Sink/basin/lavatory 25.02 5(�.al
s/ss /} y Solar units(potable water) 62.54
sty/State/Z1P: L� �-c.) 4f C-v.. Q. 4.34-"
'hone:(.5•53),S7 j 4 7 7 Fax:
t ;$s3 `a -- CAD Tub/shower/shower pan -4 12,51 05
25.02
mail: - Water closet __..^ i 25.02 a25 C'9.
C CONTRACTOR -� Water heater 37.52
3usinessname:( -6c vi by P I(er�n� ,I to(� ,yoe • Water piping/DWV 56.29
Address: U E- (4 4.-V lot✓-•e- • ,J Other: 25.02
` Subtotal -/00•�'�
City/StateJLIP: �o� b�, 0r Minimum pelmet fee: 572.50
Phone:( 3 ) 2 -ZL7-t Fax:(so')2Lotp- i'/2T
_ 5 3 ty Plan review (25%ot'permit fee) -1'
'' 7 Plumbing Lic.no.: -f
CC;13 Lic.: 4 j z�i [' (41.1i'� g State surcharge(12%of permit fee) /.2.e,/
�� � •3 .7 P/3 1't7TAl.PERMIT FEE l[�,0�
Authorized signature:���a"a""�" �i.�,y„ -7///l?
11-47 This permit application expires if a permit is not obtained within ISO days
�y�,' .t f t $ Date: 7 1 E 1 titer it has been accepted as complete.
Print name: C�.6�C c_ �' '
*Fee methodology set by Tri•County Building Industry Service Board.
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