Permit p CITY OF TIGARD PLUMBING PERMIT
I"! 1 COMMUNITY DEVELOPMENT Permit#: PLM2015-00024
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/26/2015
Parcel: 2S109AB09900
Jurisdiction: Tigard
Site address: 13160 SW HOODVISTA LN
Project: Harvey Subdivision: RAVEN RIDGE Lot: 28
Project Description: Change fiberglass tub to tile,(2)shower valves and relocate drain.
Contractor: DELTA PLUMBING INC Owner: HARVEY, KATHLEEN M
12205 SE 108TH AVE 13160 SW HOOD VISTA LN
HAPPY VALLEY, OR 97086 PORTLAND, OR 97224
PHONE: 503-998-0683 PHONE: 503 432-5970
FAX:
FEES
Quantity Description Date Amount
2 ea Tub/Shower/Shower Pan 01/26/2015 $25.02
Specifics: 1 12%State Surcharge- 01/26/2015 $8.70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment- 01/26/2015 $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 • • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Cente . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
• direct questions to OUNC . c- in. 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.
,
Plum bin' Permit A 1 s lica !L w CEIVEI)
Building Fixtures FOR OFFICE USE ONLI
City of Tigard JAN 2 6 2015 Received /a /5 I) }) 4 YS-t�C)?
13125 SW Hall Blvd.,Tigard,OR 97223 Date By: Permit No.:
Irri
�v�� s Ii Plan Review
Phone: 503.718.2439 Fax: 11 F /FARO Re eive Other Permit No.:
Inspection Line: 503.639.41 5 U !l Date Ready/By:B Juris I ill See Page►BUILDING DIVISION Notified/Method:o 1 Supplemental n Inr
Internet: www.tigard-or.go Nottfied/Method: lnformatioo
TYPE OF WORK
,:. FEE*.SC DULL: t -
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath I 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
ry g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB 3TTl R�MA.TION AND LOCATION Site utilities: _
Job site address: 13160 SW Hoocl�si �Y are Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: ] Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 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: ] Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
change fiberglass tub to tile ADD shower valve and change drain Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Kathi Harvey Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:same as above
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:(503)432-5970 Fax:( ) Ice maker 12.51
El APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan CL1) II 12.51 I 4-
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business nameaigall T ,In EJ Water piping/DWV 56.29
Address: /22 D S SE 10"U'Apf Other: 25.02
City/State/ZIP: He,e/ V411i / [�� _ Subtotal
�p'g. J Minimum permit fee: $72.50 Std
r•
Phone:(�j3) !!� �g� Fax:( )
CCB Lic.: /BZ8' Plumbing Lic.no.:.562,7_-- Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8>
Authorized signature:
/197,....._7_______ILL.-- TOTAL PERMIT FEE 81, 4-°-
This permit application expires if a permit is not obtained within 180 days
Print name: //24.1 r Date' �•D after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.\Building\Permits\PLMU-PermitApp,doe 10/01709 440-46161(10/02/COM/WEB)