Permit CITY OF TIGARD PLUMBING PERMIT
1111 Ilt COMMUNITY DEVELOPMENT Permit#: PLM2015-00043
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/12/2015
Parcel: 2S109AB07200
Jurisdiction: Tigard
Site address: 13115 SW ST JAMES LN
Project: Walker Subdivision: RAVEN RIDGE Lot: 1
Project Description: Bath remodel,(1)floor drain,(2)lays&(1)shower and(1)shower pan.
Contractor: OWNER Owner: WALKER,TIMOTHY E& LORINA B
TIM WALKER 13115 SW ST JAMES LN
13115 SW ST JAMES LN TIGARD, OR 97224
TIGARD,OR 97224
PHONE: 503-880-7132 PHONE: 503-880-7132
FAX:
FEES
Quantity Description Date Amount
2 ea Lavatories 02/12/2015 $50.04
Specifics: 1 ea Tub/Shower/Shower Pan 02/12/2015 $12.51
10 Minimum Fee Adjustment- 02/12/2015 $9.95
Type of Use: SF Plumbing
Class of Work: ALT g 12%State Surcharge- 02/12/2015 $8.70
Plumbing(manual)
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 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 FOR OFFICE USE ONLY
City of Tigard RECEIVED / �),�
111 •J g Date/B Received a/��J�S ,...,L)--)
Permit No.: 4.141015-- 4/3
Y 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598E, 1 $ 2015 Date/By:Review Other Permit No.:
T I L;A R D Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD _ Notified/Method: •WG Supplemental Information
TYPE OF VIMI i ING DIVISION FEE* SCHEDULE
❑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 312.70
1X1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry g ❑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: 13 11 S S/) ST w"rS 6.14.) Catch basin or area drain 18.76
City/State/ZIP: 'r`6 Al a2 99-024 Doting leach line,or trench drain Page 2
7 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I 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: I 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
-3 ADC "kVlA3 L_- Drinking fountain 25.02
Ejectors/sump 25.02
[PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Tim I�Aticpc Fixture/sewer cap
Address: CO Floor drain/floor sink/hub V-- -
�3I15 .S W S T u-10) Garbage disposal 2 .
City/State/ZIP: T(4 A Oft '?lit f Hose bib 25.02
Phone:( ) geo. 3-(-32_ Fax:(S-Ct )81-1 . 621(42_ Ice maker 12.51
❑ 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 a 25.02 56.4'4
City/State/ZIP: Solar units(potable water) XI 62.54 : i
Phone:( ) Fax: :( ) Tu showe shower pa� 12.51 E-mail: Urinal 25.02
Water closet 25.02
CON CTOR
Water heater 37.52
Business name: o �,vre-- Water P�tP in g/DWV 56.29
Address: Other: 25.02 s-p.
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 -
Plan review (25%of permit fee) T8-'
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) H q.
Authorized signature: / TOTAL PERMIT FEE ye,..t7
Print name: - l/.1A/Ark I Date: This/ILS This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Servi1 Board. Oe
I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB) 81
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Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
7\\1 I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
!WI NULVA-
Print Name ermit Applicant
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Permit#: k¢e 6i S- 0007(4> Pi. 'goi S-,O"/
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This Copy for Permit Offices