Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00158
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/20/2011
Parcel: 1 S133CD10900
Jurisdiction: Tigard
Site address: 13767 SW ASHBURY LN
Project: KONRAD Subdivision: COTSWALD MEADOWS NO.3 Lot: 141
Project Description: New bathtub and valve.
Contractor: CLEARWATER PLUMBING LLC Owner: KONRAD, JOHN M & KARI J
11755 SE HOLGATE 13767 SW ASHBURY LN
PORTLAND, OR 97266 TIGARD, OR 97223
PHONE: 503 - 935 -0918 PHONE:
FAX: 503 - 761 -2143
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 05/20/2011 $12.51
Specifics: 1 12% State Surcharge - 05/20/2011 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment - 05/20/2011 $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.
lab
Issued By: • - Permittee Signature:
d
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.
05/19/2011 10:51AM 5037612143 PAGE 01/02
Finn bins Permit pl c pion RECEIVE �)
Building Fixtures � roll Ot:F10E LSE ()NIA
MAY 11 2011
City of Tigard / � I ; DataBY: . // ,.i . I i - 4
13125 SW Hall Blvd., Tigard, OR 97223 IT Y OF TIGA
s Phone: 503.718.2439 Fax: 503.598.19 f Outer Permit No.:
Inspection Line: 503.639.4175 BUILDING DIVIS10 p ath zQady/gy: sl See Page 2 for
'f I G A R D Internet www.tigard- or.gov Notifed/Metbod: Supplewepts] Information
• TYPE OF WORK FEE* SCHEDULE •
❑ D exmolition For s. eclat In ormuaon use clteeklis4
Q New cotastntcfion _, _Description. WO ME Total
13 Addition/alteration/replacement El Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
' CATEGORY Of CONSTRUCTION SFR(I)bath 312.70 IIII
`---- - SFR (2) bath 437.78
El 1- and 2- family dwelling Li Commercial/industrial
SFR (3) bath 1111 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: •
• Catch basin or area drain 1.11 18.76
Job site address: 13767 sw asbbury
Drywell, leach line, or trench drain 18.76
City /State /ZIP: tigard or. 97223 . Footing drain (no- linear it.: _) =NM
Suite/bldg./apt. no.: Project name: Manufactured home utilities 50.03
Cross street /directions to job site: sw walnut . y Manholes 18.76 .111 Rain drain connector 18.76 Mil
Sanitary sewer (no. linear ft.: I Page 2
Storm sewer (no. linear It.: __) Page 2
water service (no. linear ft.: _1 Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: - Backilow preventer 31.27_
Backwater valve 12.51
DESCRIPTION OF WORK
_ _ . Clothes washer . 25.02
new tub / valve , " Dishwasher I= 25.02
Drinking ibuntain 25.02 al
4 Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT. Expansion tank 12 -51
'^ '"°' "'^ Fixture /sewer cap 25.02
Name:
.. - Floor drain /floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: - Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
rg Al'pLICANT, 0 CONTACT', PERSON . Interceptor /grease trap 25.02
Business name: Clearwater Plumbing lie. Medical gas (value: $ ) Page 2
-- Primer 12.51
Contact name: Cary Townsend
Roof drain (commercial) 12.51
Address: 11755 se bolgate Sink/brtsiNlavatory 25.02
City /State/ZIP: portland or. 97266 Solar units (potable water) MO 62.54
Phone: (503) 935 0918 1 : (503) 761 2143 Tub /shower /shower pan 1 12.51
E -mail: Urinal 25.02
Water close[ 25.02
•
CONTRACTOR ..
•
Water heater 37.52 ME
Business name: CleaWater Plumbing Be. Water piping/DWV 56.29 -
Address: 11755 se holgate Other: 25.02
City/State /ZIP: portland or. 97266 Subtotal
Phone: (503) 935 0918 Fax: (503) 7612143 Minimum permit fee: $72,50
CCB Lic_: 180730 Plumbing Lie. no.: pb554 Plan review (25% of permit fee)
-- State surcharge (12% of permit fee)
Authorized signature: .. e . '�__
l TOTAL PERMIT FEE
Thin p ermit a expires if a permit is not obtained trithia 180 days
Print name; Gary Townsend Date: 5/19/11 after it has been accepted SS complete.
"Fee methodology set by Th- County Building lade try Service Board.
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