Permit (15) CITY OF TIGARD PLUMBING PERMIT
IN iii
COMMUNITY DEVELOPMENT Permit#: PLM2016-00536
Date Issued: 10/26/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S112CA04200
Jurisdiction: Tigard
Site address: 15235 SW 79TH AVE
Project: GIBBONS Subdivision: DURHAM ACRES Lot: 29
Project Description: Replace plumbing fixtures for fire damage.
Contractor: ASCENT PLUMBING LLC Owner: GIBBONS,JEFFERY D
16133 SWAN AVE 15235 SW 79TH
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-572-5717 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 10/26/2016 $25.02
Specifics: 1 ea Garbage Disposal 10/26/2016 $25.02
1 ea Ice Maker 10/26/2016 $12.51
Type of Use: SF 1 ea Sink 10/26/2016 $25.02
Class of Work: ALT 2 ea Lavatories 10/26/2016 $50.04
Type of Const: 1 ea Tub/Shower/Shower Pan 10/26/2016 $12.51
Occupancy Grp: 2 ea Water Closet 10/26/2016 $50.04
Stories: 1 ea Water Heater 10/26/2016 $37.52
1 12%State Surcharge- 10/26/2016 $28.52
Plumbing
Total $266.20
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 obta.• - copy,of rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ------
Issued By: --- Permittee Signature:
-.T
Call 503.639.4175 by 7:00 a.m.for the next available insp= '•n 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 ApplicatRFCFIVE1).
Building Fixtures 0 C T 2 6 2016 FOR OFFICE USE ONLY
City of Tigard Received f' y�
Date/By:�Q/Zt� �(, �1, Permit NA/1020 ,-ep 15
13125 SW Hall Blvd.,Tigard,OR'.9/ 'G !°
= Plan Review
Phone: 503.718.2439 Fax: ti, T „ ? DateBy: Other Permit No.:
Inspection Line: 503.639.4175 U l t) g -'`-" `r" Ci <
T I G A R D Date Read /Bo Juris: 0 See Pagee 2 for
Internet: www.tigard-or.gov Notified/Method:
Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I Qty. Ea. Total
Addition/alteration/replacement 0 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 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: C Catch basin or area drain 18.76
�-7- Drywell,leach line,or trench drain 18.76
City/State/ZIP: J 1 IctreAQ R Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: GNI IIy1av,_,LS 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK : Backwater valve 12.51
(�� Clothes washer 25.02
de-e. 7I'- b a'` f-e -Pot t t' CL '2. Dishwasher I 25.02
U Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
GNI
Iy5r r Fixture/sewer cap 25.02
V
Name: }C^
/ Floor drain/floor sink/hub 25.02
Address: 1 52--s-5 St.J.b "A':%.'\
Garbage disposal f 25.02
City/State/ZIP: -^1-it o`t CS< Hose bib 25.02
Phone:( ) Fax:( ) Ice maker j 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: 'ait ite-e-94orck1-t6.n. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: ,„%A--C.f r-PeCt hp 2 Roof drain(commercial) 12.51
Address: >,2.TS'--3 Es i- Jot A-Irp 4- L),,C._.-1 Sink/basin/lavatory 3 25.02
City/State/ZIP: 0 kt 0 2 Solar units(potable water) 62.54
Phone:(%,y) -z tR -t.1'1 8 Fax: :(Sj-3) i l9 1 •(os- Tub/shower/shower pan I 12.51
E-mail: d06ViZi f d 'hi vS Cd� t Urinal Z 25.02
CONTRACTOR Water closet 25.02
Water heater ' 37.52
Business name: AS C'- e-4-7 4- /3/u rr,4; ti ar LL d, Water piping/DWV 56.29
Address: l6/ 3 3 ..w(4,t i A vtw". / Other: 25.02
City/State/ZIP: o ci e y'a i.1 C;-b y t 8 R. 9 7 0 trLS Subtotal '7,(P,J
1 Fax: Minimum permit fee: $72.50
Phone:(�� ` 5-1 2.. :'7/7 ( S�D3) �J 7 L o 7
CCB Li I / 2 Z 2, 7 S Plumbing Lic.no.: /-3)3 �S L/ Plan review (25%of permit fee)
f / State surcharge(12%of permit fee) /�.
Auth ed signature: Z,2--62....21:1,.,..,_21-- ✓Z , t J TOTAL PERMIT FEE �at At
viz, 01.itil 1 r / t +,t o f e l P k ho C.Z_S r 2 c jA This permit application expires if a permit is not obtained within 180 days
Print name: ate: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:ABuildingVPermitsVPLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15235 SW 79TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2016-00536
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Corrections are complete - plumbing final approved
Violation Summary:
Inspector Contractor