Permit q CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit#: PLM2015-00167
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/27/2015
Parcel: 2S 111 CA05600
Jurisdiction: Tigard
Site address: 9440 SW LAKESIDE DR
Project: Gran Subdivision: SUMMERFIELD NO.12 Lot: 676
Project Description: Bath remodel,relocate shower,sink&toilet.
Contractor: INNER CITY PLUMBING INC Owner: GRAN,CATHERINE M
6470 NE HANCOCK ST GRAN, MARIE A
PORTLAND, OR 97213 115 SAINT ALBANS RD
KENSINGTON, CA 94708
PHONE: 503-314-7313 PHONE: 503-530-8234
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 05/27/2015 $25.02
Specifics:. 1 ea Tub/Shower/Shower Pan 05/27/2015 $12.51
1 ea Water Closet 05/27/2015 $25.02
Type of Use: SF 1 12%State Surcharge- 05/27/2015 $8.70
Class of Work: ALT Plumbing
Type of Const:
10 ea Minimum Fee Adjustment- 05/27/2015 $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 ques •• •OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued :y: 7 / f Permittee Signature: \ \
... g al•t __ i
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.
Plumbint Permit Application
Site Utilities RECEIVED
111 41 City of Tigard Received � Permit No.: it/(946/ �- v/ .7� B27 15
13125 SW Hall Blvd.,Tigard,OR 972 iY 2 7 2015 Plan Review
s Phone: 503.718.2439 Fax: 503.598. '?1 Date/By: Other Permit No.:
T I c.n It n Inspection Line: 503.639.4175 y y Page www.ti and or. ov CITYOi FT�IGAR^D n' Date Ready/By: tuns: El See Pa e 2 for
g g auiLDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. Ea. I Total
'Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
IT 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
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:
�1/ �' ,/lam C Catch basin or area drain 18.76
Job site address:
yyG l % 47,21 ` Drywell,leach line,or trench drain 18.76
City/State/ZIP: `77.6mbZ h , Eric.).t Q Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: i I Project name:pASrE� Jti'T1 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
F ` ' Clothes washer 25.02
,4 ti iZ l C'[74T1I k 1/ 5/k 6t. 6/2_, Dishwasher 25.02
S%�/e %t 41- FR'/ '7/i l/[r7 134747-N_
Drinking fountain 25.02
Der-AA f Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 0T/ -, 6 Fixture/sewer cap 25.02
Address: yyc/lo 5u, L 4/ 5//') - n/f lV�/ Floor ge disposal sink/hub 25.02
/ //�� !�"'r Garbage disposal 25.02
City/State/ZIP: 774 n2(4 _ Hose bib 25.02
Phone:(. 3) 5, N) `',L, Fax:(tom ) Ice maker 12.51
❑ APPLICANT / ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name:
Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory / 25.02 2_4.0 Z
-
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan j 12.51 >IZ.41
E-mail: Urinal 25.02
Water closet 1 25.02 2 5.V2-
CONTRACTOR
n ` , l Water heater 37.52
Business name:/J/J/� ci7Y !/u'# ,Jilt //�c_ Water piping/DWV 56.29
Address: 6e/7,0 Alt-- NAikicre $7 Other: 25.02
city/State/ZIP: Pck%c it A. 0, V`. 972 / Subtotal
Phone:( :3j 3 A./- 7 3/3 Fax:( ) Minimum permit fee: $72.50 72,SZ7
CCB Lic.: /11 C L D ,61, Plumbing Lic.no.:p6 j 3q Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8.76)
Authorized signature: 7//�/ TOTAL PERMIT FEE p.d,D
Print name: ti j..F/z vLL t Date:5=2.5 `f S 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 Service Board.
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