Permit (196) lCITY OF TIGARD PLUMBING PERMIT
i
''< COMMUNITY DEVELOPMENT Permit#: PLM201800108
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/19/2018
Parcel: 2S 104C D06900
Jurisdiction: Tigard
Site address: 13599 SW BRIM PL
Project: NYBERG Subdivision: HILLSHIRE ESTATES Lot: 69
Project Description: (1)new tile shower on main level,and replacing(1)tub/shower with new tub upstairs.
Contractor: ANSPACH PLUMBING INC Owner: NYBERG, CLEVE F&DEBRA A LIVING
18380 S FERGUSON RD 13599 SW BRIM PL
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-789-3913 PHONE:
FAX: 503-631-7972
FEES
Quantity Description Date Amount
2 ea Tub/Shower/Shower Pan 03/19/2018 $25.02
Specifics: 1 12%State Surcharge- 03/19/2018 $8.70
Plumbing
Type of Use: SF 47 ea Minimum Fee Adjustment- 03/19/2018 $47.48
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: r 1W Permittee Signature: r
'
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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
F, `
Building Fixtures FOR OFFICE t SE oyl_ti
r N Received >
City of Tigard ) f Permit No._ i
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Date/By: i‘hi i ! - /"4 O i i" L' i 0e b
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13125 SW Hall Blvd.,Tigard,OR '1\)'s\
Plan Review
• Phone: 503.718.2439 Fax: 503.5 1960st DateBy: Other Permit No.:
Inspection Line: 503.639.4175 �A �( s.
T I G A R D •1' ' 1 •�e Ready/By: Juris 63 See Page 2 for
Internet: www.tigard-or.gov 4 ,‘' ,...,'.*i: btified/Method: .I'a Supplemental Information
TYPE OF WORK ` . � FEE* SCHEDULE
0 New construction 0 De•q' i For special information use checklist
Description �I Ea. I Total
i ®Addition/alteration/replacement 0 Oth ;::. 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
❑Accessory building ❑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:13594 SW BrimPlace Catch basin or area drain 18.76
City/State/ZIP: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:Nyberg Manufactured home utilities 50.03
Cross street/directions to job site:SW Benchview to SW Brimm Place 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:Hillshire Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New tile shower main level,and replace tub/shower upstairs bath with new tub. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNERI 0 TENANT Expansion tank 12.51
Name:Cleve and Debbie Nyberg Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:13599 SW Brimm Place
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)793-2310 Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Jeff Heinze Construction,LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Jeff Heinze
Roof drain(commercial) 12.51
Address:13724 SW Jenna Ct. Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)519-7626 Fax::(503)579-6120 Tub/shower/shower pan 2 12.51 25.02
E-mail:jsheinze@msn.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Anspach Plumbing,Inc Water piping/DWV 56.29
Address:18380 S Ferguson Rd. Other: 25.02
City/State/ZIP:Oregon City,OR 97045 Subtotal 3V.C'Ly
Phone:(503)789-3913 Fax:( )
Minimum permit fee: $72.50 7).szl
CCB Lic.:163776 Plumbing Lic.no.:3-429PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) `4'.,'7%,;\
Authorized signature: / 06:30_1x/ TOTAL PERMIT FEE E'r..,ii-C',
Print name: ).4/2..c /A- I._rfi(3 Date:03/19/2018 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\Penults\PLMU-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:
13599 SW BRIM PL, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2018-00108
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor