Permit CITY OF TIGARD PLUMBING PERMIT
�. COMMUNITY DEVELOPMENT Permit#: PLM2015-00205
T L G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/29/2015
Parcel: 2S 111 CC09900
Jurisdiction: Tigard
Site address: 15770 SW GREENS WAY
Project: Brumbaugh Subdivision: SUMMERFIELD NO.2 Lot: 126
Project Description: Remodel of master bathroom&kitchen,(1)dishwasher,(1)ice maker,(1)sink,(2)lays,(1)tub/shower,(1)water
closet&(1)water heater.
Contractor: ASSURED PLUMBING INC Owner: BRUMBAUGH, NANCY
PO BOX 230816 15770 SW GREENS WAY
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503-985-9093 PHONE:
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Dishwasher 06/29/2015 $25.02
Specifics: 1 ea Ice Maker 06/29/2015 $12.51
1 ea Sink 06/29/2015 $25.02
Type of Use: SF 2 ea Lavatories 06/29/2015 $50.04
Class of Work: ALT 1 ea Tub/Shower/Shower Pan 06/29/2015 $12.51
Type of Const: 1 ea Water Closet 06/29/2015 $25.02
Occupancy Grp: 1 ea Water Heater 06/29/2015 $37.52
Stories: 1 12%State Surcharge- 06/29/2015 $22.52
Plumbing
Total $210.16
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: ///-- Cj _n 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 '1 ,�JEIVEP Received /
City of Tigard �y: �Cf /� q PermitNo.: 1.149e)I Odo?o,5---
• 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
• Phone: 503.718.2439 Fax: 503.598.1 Date/By: other Permit No.:
I IC;AR n Inspection Line: 503.639.4175 1 2 9 2015 Date Ready/By: Julia: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE vkiiiiibOV [HARD FEE* SCHEDULE
❑New construction t"?1 atitifIliaPla Si 07'• For spedal information use checklist
Description 1 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
® 1-and 2-family dwelling ❑Commercialfmdustrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
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:15770 SW greensway Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/btdgJapt.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: l Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Master bath remodel,kitchen remodel Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER f ❑ TENANT Expansion tank 12.51
Name:Nancy brumbaugh Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:15770 SW Greensway
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 1 12.51
❑ APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:TL Remodel&Construction Inc Medical gas(value:$ ) Page 2
Contact name:Tim Labunsky
Primer 12.51
Roof drain(commercial) 12.51
Address:PO Box 1996 Sink/basin/lavatory 3 25.02
City/State/ZIP:Lake Oswego,OR 97035 Solar units(potable water) 62.54
Phone:(503)984-2783 Fax::( ) Tub/shower/shower pan 1 12.51
E-mail:TLRemodel @yahoo.com Urinal 25.02
Water closet 1 25.02
CONTRACTOR
Water heater 1 37.52
Business name:Assured Plumbing Inc Water Pi 1 p In WV 56.29
Address: PO BOX 230816 Other: 25.02
City/State/ZIP:Portland,OR 97281 Subtotal
Phone:(503)985-9093 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:199423 Plumbing Lic.no.:PB1055
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: 41 i y TOTAL PERMIT FEE 0,Mc
Print name:Miguel Dorraanfes Date:6/25/15 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.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440.4616T(10/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15770 SW GREENS WAY, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00205
David Young
Violation Summary:
Inspector Contractor