Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00064
Date Issued: 02/10/2020
TIGGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S104CC06600
Jurisdiction: Tigard
Site address: 13679 SW ASCENSION DR
Project: Spooner Residence Subdivision: HILLSHIRE WOODS Lot: 10
Project Description: Replacing(1)jacuzzi tub with(1)free standing tub.
Contractor: ANSPACH PLUMBING INC Owner: SPOONER, KAREN L& DAVID S
18380 S FERGUSON RD 13679 SW ASCENSION DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-789-3913 PHONE:
FAX: 503-631-7972
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 02/10/2020 $12.51
Specifics: 1 12%State Surcharge- 02/10/2020 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 02/10/2020 $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:
/14/
C
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 USE ONLY
Received
City of Tigard ,` 'E�UateBy: ,L J!0 ,� Permit No.: p/1 90 .� y_tit
1111 13125 SW Hall Blvd.,Tigard,OR 97223 V Plan Review / / �-11 t�l.V1f��
■ Phone: 503.718.2439 Fax: 503.598.1 SECS r. Date/By: Other Permit No.: a(Igo_et10
I t G A RD Inspection Line: 503.639.4175 et 11.17 le Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: - Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction ❑Demoliti4n For special information use checklist
t3 I' _ Description I Qty. I Ea. I 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 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: l 3677 5 e.v S(On) n P.
Drywell,leach line,or trench drain 18.76
City/State/ZIP: I 1 Gt'E-12 0 a q'7}-9-3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Crosse street/directions to job site: S(A) M t5 l Le. 1-0e f t) s' A Manholes 18.76
ASC eN 5 IaA) V R r 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: IA 0-4-S k ((2-e_ 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
Re eL'' _'e- ,u-ZZt 6 tit; 1 fit'l F t2 e e Dishwasher 25.02
S T*t'i"P 1 nl 6 -1-(At Q Drinking fountain 25.02
Ejectors/sump 25.02
a PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: 7,4-f e„ 1- 12-e n) CJ POONe-ie
Fixture/sewer cap 25.02
Address: '367 9 514 4SC'e N 5 t oN 0 g_
Floor gedr oor sink/hub 25.02
/ Garbage disposal 25.02
City/State/ZIP: -Ft&*12Q d 722-3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
(APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
.�n Medical gas(value:$ ) Page 2
Business name: `-P-P i4 e by z-e C.ONST12-u- t I o AI Lt-C
T I Primer 12.51
Contact name: 3` N e(N"2e.
Roof drain(commercial) 12.51
Address: 13 7 Al.( 5(,J -1--O,VA/A- t`t Sink/basin/lavatory 25.02
City/State/ZIP: '-'n(,i-(21) 01 C17 2_9.?j Solar units(potable water) 62.54
Phone:(93) S( 9,-7 6 z.6/ Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: j 5 14 e l,,t; 't_C AA.s N , (..0/✓I
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: A.N5I 4... 1 n L(4M i (/ti
Water piping/DWV 56.29
Address: i g3g0 S Fe 126u-s 0,) ]20 Other: 25.02
City/State/ZIP: 0 Fe 60/v ctT` ) d 1` 9 7 O 5- Subtotal I -sr
Phone:(6-03) Ts,?-3 47 J 3 Fax:( ) Minimum permit fee: $72.50 7,4sv
CCB Lic.: 6 3 7'7 L ( Plumbing Lic.no.: 3-li 29 P 6 Plan review (25%of permit fee)
J State surcharge(12%of permit fee) �'^j;,
Authorized signature: cS ) TOTAL PERMIT FEE ( ,
Print name: MA-(.K A e 1...4.0 Date: 2/7/.0 2_p 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.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-0616T(10/02/COM/WEB)