Permit CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00126
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2011
Parcel: 2S 1148607300
Jurisdiction: Tigard
Site address: 16221 SW 104TH AVE
Project: Rains Subdivision: SWANSONS GLEN Lot: 14
Project Description: Bathroom remodel
Contractor: BANK PLUMBING & CONTRACTING INC Owner: RAINS, ELIZABETH ANN &
PO BOX 149 ALLISON, DEBORAH S
CANBY, OR 97013 16221 SW 104TH AVE
TIGARD, OR 97224
PHONE: 503 - 266 -5955 PHONE:
FAX: 503 - 266 -5957
FEES
Quantity Description Date Amount
2 ea Tub /Shower /Shower Pan 04/20/2011 $25.02
Specifics: 1 12% State Surcharge - 04/20/2011 $8.70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment - 04/20/2011 $47.48
Class of Work: ALT Plumbing
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 Si
D/i/- f i ° G/ C" oL-770
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.
04/21/2009 20:44 5032665955 TRISTA PAGE 01/02
Plumlbina Permit Application ��
l OR (in
Building Fixtures �� , 1(L I si ONI\
City of Tigard ��1 E : " 2 p j 411 131SW Hall Blvd., Tigard, OR 9 Q �. ew ether Permit No.:
I Phone: 503,718.2439 Fax: 503.598.1960 + Date/By:
Inspection Line; 503 639.4175 Q Q Q 1
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❑ �, bn .for s, eclat in ormarion use checklist.
❑ New wnstruction 1 O� t Descri, ' on FM1 Ea. Total
Irk<ddttion/alteration/replacement ❑ Other: New 1- 2- family dwellin_er (includes 100 ft. for each utility connection
°"" )1 1 ^r, if^Fn , 1 �riir r era t m 1 i,1R SFR 1 bath 312.70
r llg t L r �i ! „; ', r a r rt e th 1 ;74,.. ti J a 51/ EI N N , I reNgh orIT +' E - 6111 ( )
ra.Eaa �.na. ,. .» . ,.,w �, +.a , z .,.r.a t +n, tm,, i a I r.. i; SFR (2) bath 437.78
and 2- family dwelling ❑ Cornrrteroial/industrtal SFR (3) bath 500.32
❑ Accessary building ❑ Multi-family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other! Fire sprinkler ( sq. ft.) Pa 2
r,r� .,, , rt 7 7„" r :77 FTT d 7 ;It'+ Tt +7112 pEI r tnr rt i , +
li ggr t g [ 1 j� Y H' . 7t � . r �'� '+F+ta ,4 l�ilh441✓I it if! :' j , i S u
F.t a tnrFd +4!.a�n „r�r 11 l , r ,, ..1.s��,.,,.., Catch basin or area drain i 18,76 -
Job site address: . ��lh.) 1 cy-on.
tt Diywcll, leach line, or trench drain 18.76
City /State/ZIP: r r j i Q� 0 .- 1 a ' Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: milir Project name: 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.: ,) r
Subdivision: Lot no.: Fixture or item:
Backflow preventer 31, -
Tax map /parcel no
�, " "1 Etr .�- Vii - z , to -c:+ I A 4 1' s Backwater , Ba valve 12 51 �a
r1 r 7 -,} ! e O t ,J 1 d d l V..) f t .. L.. d::d L',4.1ilL i to f, e 25.02
fi ,, .+...vi:rnl , , . td' .. , ,,, Clothes washer
r - Q.CY7(' Qk Dishwasher 25.02
Drinking fbuntain 25.02
Ejectors/sump 25 02
1 1221 R o (�; �� L stT r n�?7,11,D Ir.∎r airr..F7 :H +n� + '' ir1i y L' ?H�i+�' 1 f3 tr '
Y lrr } ) t rt
Expansion tank 125
r k .» r'I1 r. F _ ; , „ . : : ' . „ t : -,7 . B 1 ' ' la - 4114 . rt ,a- i ii 25.02
Name:
/ *A S I-1/ 0/1-467774 Fixture/sewer cap
/ Floor draitUfloorsink /hub 25,02
Address: 5 Garbage disposal 25.02
City / State/ZIP: hose bib 25.02
Phone: ( ) Fax ( ) Ice maker 12.51
r.� 4?I ?hfl'2Zt"�r i a 71 r 2- ;_ li }�! ; r ^ .d� P��,t v,a 1i4 J � i' t Interceptor /grease trap 25.02
tC'y.. ^� L, i19F �! i -: ��' r 7 r a .�. .... ...u.^.... H _..,� . if�.1 '^ r^,. � »;L, ��.l�rtl�r
Medical gas (value: $ ) Page 2
Business name: �fkt-\ _ iiD\ at& � �
Primer
Contact name III ' Roof drain (commercial) 12.51
Address: Mlio. MILIka Sink/basin/lavatory 25.02
City /State/ZIP: a _ Og, • ill Solar units (potable water) 62.54
Phone: (5 *) z LpLe 0 3i G05 Fax:: . )2. 1 . - Tub /shower /shower pm LIM 12.51
Urinal 25.02
E-mail: 1 a .. s )VM a1 • • t t--
Z Water closet 25.02
'�'! i fit (l { i5 + gE j l F � t�.' (!- b � + F, V 1r S ii i�i�v �i , 1 + ,! rr• I ^'! i t 1 ,r-
1 1
li ��;U F .41," .: I ... ? ,7Z ,tk. .4r a. '/ r gin-7, s , - ,44 Water heater 37.
Business name: op 'i_li% O\L) r'eN\C, '" Water pipingfDWV 56.29
Address: a p, lNo Other: 25.02
City/State /ZIP: C (Z • _L Cl: Subtotal
� 1 Minimum permit fee: $72.50 URN
Phone: ` ) , 5Cj Fax: ( S _ Plan review (25% of permit fee)
CCB Lic.: 1 J it Plumbing Lic. no.: V '"a3 \
State surcharge (12/0 of permit fee) InIM
Authorized signature: �� �` TOTAL PERMIT FEE ri2M
This permit application expires if a permit is ant obtained within 180 days
J
Print nam . Date: r, , after it has been accepted as complete.
"tree methodology set by T*+- county Build ing Industry Ser4ce Board.
r:l Ztui iding \Pomnit81Pr,MU- PertnitApp.dOC 10(01/08 440- 4616T(10 /ozCOM l)