Permit CITY OF TIGARD PLUMBING PERMIT
2 ' • COMMUNITY DEVELOPMENT Permit #: PLM2011 -00097
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2011
Parcel: 2S 104CD07000
Jurisdiction: Tigard
Site address: 13577 SW BRIM PL
Project: COOK Subdivision: HILLSHIRE ESTATES Lot: 70
Project Description: Shower install.
Contractor: 3 MOUNTAINS PLUMBING Owner: COOK, ROBERT FRANK & TERESE JUST
PO BOX 230051 13577 SW BRIM PL
PORTLAND, OR 97281 TIGARD, OR 97223
PHONE: 503 - 670 -1342 PHONE:
FAX: 503 - 828 -0515
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 03/30/2011 $12.51
Specifics: 1 12% State Surcharge - 03/30/2011 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment - 03/30/2011 $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:
Call 503.• 9.4175 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.
MAR-29-201 1 16:26 From: To:5035981960 Page:3'3
Plum bin Pen__,.,,g___
Building Fixtures FOR OFFICE 1_ ONL1
i City of Tigard
D R1, B eive y d, _ ..3 ,, , /1 077 Permit No,: piii,),(:),o-tb09 7
q 13125 SW Hall Blvd., Tigard, OR 97223 -
Plan Review
I Phone: 503,639,4171 Fax: 503.598.1960 Other Permit No.:
Datc.Sy:
Inspection Line: 503.639.4175
TIGARD Date Ready/By: _Jud Ed See Page 2 for
Internet! www.tigard-or.gov Notificd/Metttod: a-n, Supplemental Information
k 8frlit5CiF , ivVitkii: :: - ...: :‘ . .: i ,''. : : . - :•'''.:':] . ::.:•:,:: v:*EE. SCHEDULE:::::'
in New construction in Demolition For special information use eheeklim .
Description I Qty- I Ea- I Total
Addition/alteratiordreplacement 0 Other: New I - 2 dwellings (includes 100 ft. for each utility connection)
1 ""•:,' ' 7. ' .' '' '' ' '..7'. : ''; r' 6A:ft66fiV OF 66i4§iiiiielioNi..'":'' SFR(l) 249.20 '
til 1- and 2-family dwelling ...
1=l Master builder D Commercial/industrial
0 Other: SFR (2) bath
SFR (3) bath
Each additional bath/kitchen
Fire sprinkler ( sq, ft,) 350.00
50.00
0 Accessory building I:1 Multi-family
3
45.00
Page 2
1 .if.c ' i 1 P ' :: 00 0 1 M .4 tON -4i !Nli0 ). Wi!C*:':' : ' ' : : 4' ...'1'. ' '''''' Site utilities
Job site address: / ?' 5; At : rY7 / Catch basin or area drain 16.60
City/State/ZIP: 77 ,,,,,,r
a•
Project name: a_ , c I t eoth- Fooling drain (no. linear : Drywell, leach line, or trench drain
it ) 16.60
Suite/bldg/apt, no.:
Page 2
Cross street/directiOns to job Site:
Manufactured home utilities
Manholes
110.00
16.60
Rain drain connector
16.60
Sanitary sewer (no. linear ft.: )
Page 2
Subdivision: Lot no.: Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: )
Page 2
Tax map/parcel no.:
. . . .
TION.'or' won( „ , ,,,J . :,..,:,__ ,:.... :.:.. ,i,,:. . , Fixture or item
Absorption valve
Backflow preventer 16.60
Page 2
'Il-ert-J ilel-Ltiak / Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
'F' "LI: !PkOgEitT300WNCR::' ::' "' ':: " I . - . Itt TENANT ''::
Ejectors/sump 16.60
Name:
Expansion tank 16.601
Address: Fixture/sewer cap 16.60
City/State/ZIP:
El Floor drain/floor sink/hub
Garbage disposal 16.60
b. A F roc.A.r,..,;.':, ‘.:.. ' .- : : CONTACT iFERscqs ':.. : "Hose bib 16.60
Ice maker 16,60
Phone: ( ) Fax: ( )
16.60
Business name;
: Interceptor/grease trap 16.60
medical gas (value: $ _ )
Contact name
Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
sink/basin/lavatory 16.60
Phone: ( ) Fax: : ( )
Tub/shower/shower pan 1 16.60 t C. ej'
E-mail: . Urinal 16.60
;i:!; CONTBACTOK, :.,, ,".'":: 1 1 :.!1: - ' •: ' ' , :,i Water closet 16.60
Business name: /77 ,,71,4),.-15 t'n .4. Water heater 16.60
Other:
Address: p 00 , „,..,7- 7
Subtotal
City/State/ZIP: ■-•'/- / e2 -- 7.0 V Minimum permit fee: $72.50
Phone: ( ) ‘ 96, fl g ... Fax: ( ) 4 : 2 5 - / r Residential backflow minimum permit fee: $36.25
cat Lic.: /‘Vgqf plumbing Lic. no.: P/3 / - Plan review (25% of of permit fee)
permit fee)
/V State surcharge (12%
Authorized signature: /WI."' e .0_ TOTAL PERMIT FEE fel A A,
Print name Date: 5 ,,,9 ?, t his permit application expires It a permit Is nut UUlalleeta 'village
180 days after it has been accepted as complete.
°Fee methodology set by Tri-County Building Industry Service Board.
IN;hadinpamitOLMF-PermitApp Aloe 1747/ 440-4616T(lotcrucommes)