Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit#: PLM2016-00193
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2016
Tic;;\Iz C� g Parcel: 2S110DD01100
Jurisdiction: Tigard
Site address: 15940 SW GREENS WAY
Project: Christensen Subdivision: SUMMERFIELD Lot: 89
Project Description: Shower installation.
Contractor: ASSURED PLUMBING INC Owner: CHRISTENSEN, BRIAN&DIANE MARIE
PO BOX 230816 TRUST
PORTLAND, OR 97281 1090 NORTHVIEW DR
BEAUMONT, CA 92223
PHONE: 503-985-9093 PHONE:
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 04/11/2016 $12.51
Specifics: 1 12%State Surcharge- 04/11/2016 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 04/11/2016 $59.99
Plumbing
Class of Work: ALT
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: 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.
Plumbing Permit Application
Building Fixtures ."-tcct.,iV
Received '/
City of Tigard :z DateBy: 7 ii `/n Permit No.: �//1/��? /6 tf q,g
13125 SW Hall Blvd.,Tig.. 9 Plan Review T t i ,04J6
■ Phone: 503.718.2439 Fax:. 7g. 8.1960 ,�01. Date/By: Other Permit No.:1fe 15:- ne Jq
Inspection Line: 503.639.41 1 Date Read B Juris• ® See Page 2 for u`SN�" I
IR, �`� Y Y
Internet: www.tigard-0Ggov ^ �i- - O Notified/Method: Supplemental Information
TYPE OF W `.t FEE* SCHEDULE
0 New constructions,`! For special information use checklist
11� Description Qty. I Ea. I Total
®Addition/alteration/replacement Alli t1er: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15940 SW Greens way 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/bldg./apt.no.: I Project name: C ,r,sta11/ex->A 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
I walk in shower
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Q� Name: Brian&Diane Christensen Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
-.. Address:15940 SW Greens way. Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:TL Remodel&Construction Inc Medical gas(value:$ ) Page 2
Primer 12.51
SS Contact name:Tim Labunsky
3 Roof drain(commercial) 12.51
Address:PO Box 1996 Sink/basin/lavatory 25.02
.7' 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 f�.5-7E-mail:TLRemodel@yahoo.com Urinal 25.02
Water closet 25.02
® CONTRACTOR
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 /)_5-/
Phone:(503)985-9093 Fax:( ) Minimum permit fee: $72.50 7).v
Plan review (25%of permit fee) -
CCB Lic.:199423 Plumbing Lic.no.:PB1055 State surcharge(12%of permit fee) �.7p
Authorized signature: TOTAL PERMIT FEE ' a,,
Print name:Miguel Dorantes Date:4/11/16 This permit application expires if a permit is not obtained withinY80 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WE13)
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
15940 SW GREENS WAY, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00193
Don Sylvester
Violation Summary:
Inspector Contractor