Permit CITY OF TIGARD PLUMBING PERMIT
t ' • COMMUNITY DEVELOPMENT Permit# PLM2011 -00191
Date Issued 06/15/2011
TICAAD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439
Parcel 25115AA04600
Jurisdiction Tigard
Site address 10827 SW CHATEAU LN
Project TEMPLIN Subdivision REBECCA PARK Lot 3
Project Description Bathroom remodel 10/25/11, reprinted permit to include (1) tub
Contractor BANK PLUMBING & CONTRACTING INC Owner TEMPLIN, RAYMOND JEROME
PO BOX 149 10827 SW CHATEAU LN
CANBY, OR 97013 TIGARD, OR 97224
PHONE 503- 266 -5955 PHONE
FAX 503 - 266 -5957
FEES
Quantity Description Date Amount
1 ea Lavatories 06/15/2011 $25 02
Specifics: 2 ea Tub /Shower /Shower Pan 06/15/2011 $25 02
1 ea Water Closet 06/15/2011 $25 02
Type of Use SF 1 12% State Surcharge - 06/15/2011 $9 01
Class of Work ALT Plumbing
Type of Const 1 ea Tub /Shower /Shower Pan 10/25/2011 $12 51
Occupancy Grp 2 12% State Surcharge - 10/25/2011 $1 50
Stories Plumbing
Total $98 08
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 33••
Issued By - Permitted Signature
A.`.ei
I
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
CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit #: PLM2011 -00191
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/15(2011
Parcel: 2S115AA04600
Jurisdiction: Tigard
Site address: 10827 SW CHATEAU LN
Project: TEMPLIN Subdivision: REBECCA PARK Lot: 3
Project Description: Bathroom remodel.
Contractor: BANK PLUMBING & CONTRACTING INC Owner: TEMPLIN, RAYMOND JEROME
PO BOX 149 10827 SW CHATEAU LN
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -5955 PHONE:
FAX: 503 - 266 -5957
FEES
Quantity Description Date Amount
1 ea Lavatories 06/15/2011 $25.02
Specifics: 2 ea Tub /Shower /Shower Pan 06/15/2011 $25.02
1 ea Water Closet 06/15/2011 $25.02
Type of Use: SF 1 12% State Surcharge - 06/15/2011 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:'
Stories:
Total $84.07
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 estions to NC by calling 503.232.1987 or 1.800.332.2344. .
Issue By: 1 Permittee Signat .
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.
•
06/15/2009 20:41 5032665955 TRISTA PAGE 02/03
Plumbing Permit .Applicatio ECEIVED
Site Utilities 1
1 JUN 1 4 2011 l OR Orr - (-SL oNn
City of Tigard j Received ; l t • ( Map p
1 .,
Permit 00/
4. 13125 SW Hall Blvd., Tig d OR 97TY OF TIGARD Date/By: P erm (,�v`�
1 III Phone; 503.718.2439 Fax: 503,5 BINDING DIVISION Da./ `W Other Permit No.:
T I CI A s; I7 inspection Line: 503.b34 Date Ready/By: runs: El See Page 2 for
Internet: www ttgard _or.g v
Notified/Method: Supplemental r
sr_ f � y*',yri7'+{ ,ri^'j+; •r" � � ... . i . ¢ . tr ,�^ i..v ry PP information
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it -t: .tiiii>�.wc!-: ;la tifl.�' I'`.i' { 4r I ig ti !o r {! , I a rW 4 o')1 v y ,, t o ti tea Ct. I !1 {� {: - - .4-.
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El New construction " r
i 0 For special
Description I Qty. I Ea, I Total
ddu J lon/altcration/replacement 0 Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection)
g l9{ ` }`a r lir"iska ai. v i; LrLll�+ �si �,�,1, s Y' ` r " ° k ,+l's ' Ot a9t' ill SFR (1) bath
to I ? z� f r (( i . ., ,. Iii) t, 312.70
1! - and 2- family dwelling 1 0 Commercial/industrial SFR. (2) bath 437,78
El Accessory building � ❑ Multi - family SFR (3) bath 500.32
❑ Master builder r Each additional bath/kitchen 25,02
❑ Other, Fires r,
a , . a "' f i r a, �r .17. s"a -sr n n N t sprinkler ( sq. ft.) Page 2 •
liil)(t ll"i {art k j n ' r si "x rk ? 4,' ..1 tr 1 G G� 1 t A. i 1, ..(. i�tkm, -6 P Site uti!Ides.
:: ::,,1 ,.,,,„'is,, .•:tit tli,', -_,,G 14
G, ,'l CY��e�� 1_,C-1 Catch basin or area drain 18.75
Job site address: IF —
City /State /ZIP: 00—, on e atA Footing drain line, oe trench drain 18.76
e ■ hooting drain (no, linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name: Manufacture home utilities 50.03
Cross street/directions to job site: Manholes 18,76
Rain drain connector 18.76
Y Sanitary sewer (no, linear ft.: __) Page 2
Storm sewer (no. linear ft.: ) Page 2
—
• Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: ; Backflow preventer 31.27
' �l�t {�z'1 ( '' i f - } tli�� y Ik( ; "1r V n l . f.'' f in y FIt ' .i t m s I t rr , - {pig Backwater valve 12.51
rt'! t1a2' .tai,l�},gi tY' il _ `. :17 n n, ,,, 14,,t: '���p 6411t, f .' }
Clothes washer 25.02
Q Dishwasher 25.02
1
Drinking fountain 25.02
I _
Ejectors /sump 25.02
t , ryP � r �'rj"'1'ttl'ry, lgTlT vs,t 1a, IA7 i« C""% if ltltRA7N �{ a re
:f:.:iDMu 1t .' l3} ,,y« ?-] i �ak�{^� d . n � O•V :S.I a�i,, .r,I - i r1' "' Rrai 13! , o � 1 a !^ -r- .,ii,
Expansion tank 12.51
L" t !!1 .d a { {. le
Marne: Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25,02
City/State /ZIP: Hose bib 25.02
Phone: (
i
�i Y 1' ,, ,�''( 1K( {tav, ) /ry rsae`s ,�lre a 3� n E ' +, 't>{ �! ( ++ru ) , sTdS"" tttF1[I" t Ice maker 12.51
,1u�,a„ i Aw1h a a (a } ,,ha rsi x ! udin,�s 44,i` , ` t I . � a Interceptor /grease trap 25.02
Business name: Medical gas (value: $ �) page 2
Contact nano: Primer 12.51
Address: -1 _4 i i 1� nn ��� Roof dram (commercial) 12.51
rev Sink/basin/lavatory L 25.02 2.5,0 - a
City/State /ZIP: f_..) ;_ Solar units (potable water) . 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 2 5 , ( j,
E-mail: tip i • jar sic . 46 ■ d Urinal 25.02
N giniTi i4�, O w r r� c tt"1P0 N I f t } I a
. � t /i [� `� 2 a at s '�'�# :�:,_ � � i.� ,i >li Water closet / 25.02 � j;GJ�
!
ah ^..,,, i u... e e , r,,, a ,,, ,I t l�' . A11 t r t sr, e!L . r i' a 1 . ,... ,,4 ht t 0 lr5
business name: water heater 37.52
� � ��UMng Weicrpiping/DWV 56.29
Address: r � \ C' U Other: 25.02
City /State /ZIP: C_Ce.k.c—\\QsA 62_, Criss 3 Subtotal / 5_ ac,
phon ) 2L11 _. S °a Fax: ) G�--- Minimum permit fee: $72.50
CC/3 Lic.: 7 y V Plumbing Lie, no.: � , 1 Plan rev ie v (25 °10 of permit fee)
State surcharge (12% of permit fee) ICI , Q,
Authorized ' ,c.7.'' T TOTAL PERMIT FEE .01
Print name: � 5 A (16.1.-c— Date: (j ( 1 1 , This permit application e if a permit is not obtained within 180 days
after it bas been accepted es complete.
*Fee methodology sel by Tri- County Building Industry Service Board.
t' 16Uitding \Pormits\PLMU "PermitApp.doe 10 /01/09 440 4616T(10/02/C0M/wEs)
10/26/2009 22:01 5032665955 TRISTA PAGE 02/02
Plumbing Permit Application 1
` . t4r t Odd ` kt3 �GI 0 , ml�
Building Fixtures
City of Tigard ta Received
Permit
ll �� No PLM2011 -00191
.I C + 13125 SW Hall Blvd , Tigard, OR 99227fm p 13 V"
Phone. 503 718 2439 Fax 503,598 1960,,p ` It � Plan
a, y
Review
Inspection Line. 503.639.4175 U r Other Parma No •
l 16 T l: l? ' (\ .3 I s bete edi y tent See rage 2 for
Internet www tigard-or gov C( C��
gam. yea -t .t n r i ea \J NoafledlMethed Supplemental taferreabon
� a : ' ) NR 4 ' i ril' �, 50 , 7 a l O� F tnf i _ r — • r� a ' i Esc« rT"v"; y : 1• 1. r 1
s . 'I): ,si 'rr`'. , r y l i �I' t , Jt 1L-0.. kia } - .,k L�r ! n i tlCu t i e i .
I p At
"°' For speckallrlformaon use checklist
❑ New codswetion ❑ penf
Dcscnptwn I Qty f Ed J Total
CO Addition/alteration/replacement ❑ Other.. a New 1- 2- family dwellings (includes 100 ft for each utility connection) _
1, NilM d n r i ' =; n �'` l a. `d4 ie`� "t _ SFR (1) bath 312 70
1.- _ � t�.. .. aan , e -
® I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437 78
❑ Accessory building ❑ Multi - family SFR (3) bath 500 32
Each additional bath/kttohen 25 02
❑ Master builder ❑ Other:
, dl,F _ �{{Y w � q Fire sprinkler ( sit 8) Page 2
4f 4 a5 .. 1 •x) c r ' Ja , at •In x- z. ', (
•_._ hl a 9 a ,I, $ife uhr jtiea :
Job site address: 10827 $W Chateau In Catch basin or area drain 18 76
City/Slate /ZIP. Tigard OR Drywcil, leach line or trench drain 18 76
footing dram (no linear ft . ) Page 2
Suite bldg /apt no. I Project name Manufactured home utilities 50,03
Cross street/directions to job site Manholes 1876
Ram drain connector 18,76
Sanitary sewer (no linear ft. ) Page 2
Storm sewer (no, linear ft.: _) Page 2
Subdivision: Water service (no linear ft' ) Page 2
Lot no.: Fixture or Item:
Tax map /parcel no : Back preventer 31.27
ig O N it, n ,y tr. ,, , r .', vw liffi ,- a �. ° � , y .d )� -.. " :iil� .l; is Backwater valve 12 51 ikitio.
tub replace Clothes washer 25 02
Dishwasher 25 02
Drinking fountain 25 02
tt�� j} I E)ectors/sump 25.02
ti 4 �t: 1v4,1 /, t � s I +%ar;,i� �Slr,9 d, ?. � r.�.� 7 Expansion tank 1251
Name' Fixture /sewer cap 25 02
Address: Floor dram/floor sink7hub 2502
Garbage disposal 25.02
City/State/ZIP. Hose bib 25.02
Phone ( ) Fax ( ) Ice maker 12 51
n' yl J"d t a:e � i il 9 t3. �° ° i n :�eka i t . '1 Interceptor /geese trap 25 02
t • n n i' IaNi .ei c "4.
Business name Medical gas (value. $..) Page 2
Pruner 12 51
Contact name:
Roof drain (commercial) 12 51
Address: SmkWbasinfiavatory 25.02
City /$rate /ZIP_ Was units (potable water) 62 54
Phone. ( ) ( Fax.. ( ) Tub /shower /shower pan 1 _ 12 51 12 51
E -mail: Urinal 25 02
!l1M •", dui ll 1 a i. %%1 igodil a av I 111ip Water closet 25 02
w heater 37 52
Business name: B Ayres Plumbing
Water piping/DWV 56 29
Address PO box 149 Other. 25 02
City /State/ZIP: Canby OR 97013 Subtotal / 4 , T)
Phone (503) 2665955 Fax: (206) 2665957 Minimum permit fee S72 50
CCB Lie • 173825 Plumbing Lie no. P13301 Plan review (25% of permit fro)
State surcharge (12% of permit fee) i ,S
Authorized signatu e:. k s t. ` TOTAL PERMIT FEE ly,
Print name Trista Ayres Date; 10!252011 This permit applicationenpires if a permrtls not obtained within ISO sl ays
after it has bozo accepted as compiete
"Fee methodology set by Tn- Counly 'Budding Indvshy Service Board
1 tauddins\PermitalMU.PcrmlApp doe 10/01/09 440 -4616T(IONLCOMN /Ea)