Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit: PLM2018-00408
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/30/2018
T t c_ ;�I Dg Parcel: 2S104CA10400
Jurisdiction: Tigard
Site address: 13688 SW JENNA CT
Project: GOETZ Subdivision: HILLSHIRE Lot: 104
Project Description: Replacing(2)bath tubs and(1)shower for bathroom remodel.
Contractor: ANSPACH PLUMBING INC Owner: GOETZ, STEPHEN F&MEGAN M
18380 S FERGUSON RD 13688 SW JENNA CT
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-810-4774
HONE: 503-789-3913
FAX: 503-631-7972
FEES
Quantity Description Date Amount
3 ea Tub/Shower/Shower Pan 08/30/2018 $37.53
Specifics: 1 12%State Surcharge- 08/30/2018 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment- 08/30/2018 $34.97
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: /
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 FOR OFFICE 1SE 0\1:}
City of Tigard Ar3 Received 30/l�� ,ii1 i Z 'F�-,( )q 7 Q
�'"
iu 3 0 2 0 a 1 8 DateBy: Permit N .9 O
III a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A H D Inspection Line: 503.639.4175i Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE'OF.WORT `EE*SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. Ea. Total
lid 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 ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑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: (3 6 '? S,w .J i,/A)A c_.-r.
Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Ti GA f o 0 12 77.2 2 3
r Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 51A/ El S5 e>4. 1-c.) S t.4) Manholes 18.76
i(N A CT; 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: 1-4(Li-5-ti I 12 e_. I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DRIPTION OF WORK
Backwater valve 12.51
Clothes washer 25.02
I'1 J° 4JA•Th roci M tee MO O e L T O Dishwasher 25.02
(?ATi 11 'l 1A.(3 5 A(j 0 a(J e s tflot,tie e. Drinking fountain 25.02
Ejectors/sump 25.02
n PROPERTY OWNER" I 0 TENANT Expansion tank 12.51
Name:
5-1-e V e An)2 /111e.G't IV G o e•-t- Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 136( ' 5wC}/1/iV/ CT
Garbage disposal 25.02
City/State/ZIP: i (6/(ZOO C) at 9 72-2-3 Hose bib 25.02
Phone:(lj(3) ' 16-ii779 Fax:( ) Ice maker 12.51
APPLICANT :v 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: , r-,....._s--,...c.• ri e,,,o Le C d,„51 Rat((( ,�} L LC Medical gas(value:$ } Page 2
Primer 12.51
Contact name: .--t.-IN c(N 2f
Roof drain(commercial) 12.51
Address: )p22_11 sLA- ,Jt"N,fArt} CT Sink/basin/lavatory 25.02
City/State/ZIP: T) Cy,� 2.V,2 ' 0 72-2-"-; Solar units(potable water) 62.54
Phone:(;O3) S(c(- ''(G 6j Fax::( ) Tub/shower/shower pan -..3 12.51 ,3 75-3
Urinal 25.02
E-mail: 35v1e ( Ni -2.e6-t.), 5 Ai , C-c)A4
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: A P 5PA L.(.-lt X7LI.&(rl 3I N G Water piping/DWV 56.29
Address: 1 %3 O 5 fee 6.l($a N ie g9 Other: 25.02
City/State/ZIP: ( )Zt GG/J C-i T y 0 0,_ 76o f C Subtotal
)
(J�
Phone: C7 7�7 -3�I Fax:( ) Minimum permit fee: $72.50
CCB Lic.: /6 776 Plumbing Lic.no.: g- q p/ Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: ///1/14/2, .. 0( "'6wki Date:Z/3 0/1 4 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\Permits\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:
13688 SW JENNA CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2018-00408
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor