Permit 11111 CITY OF TIGARD PLUMBING PERMIT
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I ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00367
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/26/2015
Parcel: 2S103CC11100
Jurisdiction: Tigard
Site address: 12285 SW WHISTLER'S LN
Project: Motta Subdivision: WHISTLER'S WALK Lot: 58
Project Description: Install(2)tub/showers,(1)toilet&(2)lays.
Contractor: ASSURED PLUMBING INC Owner: MOTTA, KRISTY A&MARK J
PO BOX 230816 12285 SW WHISTLER'S LN
PORTLAND, OR 97281 TIGARD, OR 97223
PHONE: 503-985-9093
PHONE:
FAX: 971-249-3145
FEES
Quantity Description Date Amount
2 ea Lavatories 10/26/2015 $50.04
Specifics: 2 ea Tub/Shower/Shower Pan 10/26/2015 $25.02
1 ea Water Closet 10/26/2015 $25.02
Type of Use: SF 1 12%State Surcharge- 10/26/2015 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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• - • • •UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / tr/tr_—,14AA--46f 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 ApplieR CE1VE1 fI
Building Fixtures / �/ 1 Olt 01i 1( 1. I Sl. OM.l
City of Tigard OCT 2 6 2015 Date/By: ( pt /5-- Permit No.: 1 dt i S aO 367
II IN13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
5 Phone: 503.718.2439 Fax: ail- BB 1l Date/By: ther Permit No.:
Inspection Line: 503.639.4D17i S 1�� � y
T I G A R D Internet: www.ti and-or. og ILDING D1V1SIO1 Date ed/Met o: kris: S See Page l Information
g g � Notified/Method: Supplementallnformation
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description 1 Qty. j Ea. j 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
SFR(3)bath 500.32
❑Accessory building ❑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:12285 SE Whistler lane Catch basin or area drain 18.76
City/State/Z1P:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Flo ii- 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
2 tub shower,1 toilet,two sinks
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name:Mark Mona Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:12285 SE Whistler lane
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:( ) 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 2 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 p�P� P�1 m WV 56.29
Address: PO BOX 230816 Other: 25.02
City/State/ZIP:Portland,OR 97281 Subtotal /OQ,e g
Phone:(503)985-9093 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:139421 /94/4;7..5 9�r/7 Plumbing Lic.no.:PB1055 Plan review (25%of permit fee)
State surcharge(12%of permit fee) /°"O
Authorized signature: j `�c , ,t Ai_i TOTAL PERMIT FEE Ma
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Print name:Miguel Dorante Date:10/26/15 This permit application expires if a permit is not obtained within :0 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
12285 SW WHISTLER'S LN, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00367
Chip Barnett
Violation Summary:
Inspector Contractor