Permit CITY OF TIGARD PLUMBING PERMIT
1111 B COMMUNITY DEVELOPMENT Permit#: PLM2015-00230
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/21/2015
Parcel: 25111 DB08700
Jurisdiction: Tigard
Site address: 15430 SW OAKTREE LN
Project: Thorne Subdivision: SUMMERFIELD NO.10 Lot: 548
Project Description: Install(1)dryer vent and(2)exhaust fans.
Contractor: ASSURED PLUMBING INC Owner: THORNE, CLIFFORD D JR
PO BOX 230816 THORNE, STEPHANIE E
PORTLAND, OR 97281 15430 SW OAKTREE LN
TIGARD, OR 97224
PHONE: 503-936-5342
HONE: 503-985-9093
FAX: 971-249-3145
FEES
Quantity Description Date Amount
2 ea Lavatories 07/21/2015 $50.04
Specifics: 1 ea Tub/Shower/Shower Pan 07/21/2015 $12.51
1 ea Water Closet 07/21/2015 $25.02
Type of Use: SF 1 12%State Surcharge- 07/21/2015 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.08
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 irk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification Ce -r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You y obtain a copy of the rules
or di ct questions to OU • -.ling 503.232.1987 or 1.800.332.2344. ^7
Iss d By: / 4 A 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 RECEIVED , ,,I, I„ I ,1 I I ,, ,", ,
City of Tigard 1L LL Permit No.: �L j ,i 6710,- de
13125 SW Hall Blvd.,Tigard,OR 9A47 2 1 2015
Plan Review
Phone: 503.718.2439 Fax: 5 3.598.1960 Date/By: Other Permit No.:
i i k l Inspection Line: 503.639.4175 U I TY OF 1!G AR D Date Ready/By: runs Fa See Page 2 for
Internet: www.tigard-or.govC3UILD!NG DIVISION Notified/Method: Supplemental Information
TYPE OF WORK 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
® 1-and 2-family dwelling ❑Commercial/industrial 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:15430 SW Oak Tree Lane 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.: I Project name: -40/4)0O Manufactured home utilities 50.03
Cross sheet/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
washer box,2 lays,toilet,1 shower Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Cliff Thorne Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 15430 SW Oak Tree lane
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:( ) I Fax:( ) Ice maker 12.51
❑ APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:TL Remodel&Construction Inc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Tim Labunsky
Roof drain(commercial) 12.51
Address:PO Box 1996 Sink/basin/lavatory 2 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
CONTRACTOR Water closet 1 25.02
Water heater 37.52
Business name:Assured Plumbing Inc Water piping/DWV 56.29
Address: PO BOX 230816 Other: 25.02
City/State/ZIP:Portland,OR 97281 Subtotal ST •P 7
Phone:(503)985-9093 Fax:( ) Minimum permit fee: $72.50 ' �---.
CCB Lie.:199423 Plumbing Lic.no.:PB1055 Plan review (25%of permit fee)
State surcharge(12%of permit fee) /t) 51
Authorized signature:'/S TOTAL PERMIT FEE 9
Print name:Miguel Doran Date:7/17/15 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.
1-\Building\Petmits\PLMU-PermitApp.doc 10/01/09 440-4616T(I002ICOM/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
15430 SW OAKTREE LN, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00230
David Young
Violation Summary:
Inspector Contractor