Permit •
CITY OF TIGARD PLUMBING PERMIT
II I 111 : in
- COMMUNITY DEVELOPMENT Permit #: PLM2009 -00213
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/06/2009
Parcel: 1 S 135CC01500
Jurisdiction: Tigard
Site address: 10275 SW MEADOW ST
Subdivision: Lot: 0
Project: Nelson
Project Description: Tub to shower conversion.
Owner. FEES
NELSON, BETTY Quantity Description Date Amount
10275 SW MEADOW ST
TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 08/06/2009 $16.60
PHONE: 503 -639 -0573 1 12% State Surcharge - 08/06/2009 $8.70
Plumbing
56 ea Minimum Fee Adjustment - 08/06/2009 $55.90
Contractor: Plumbing
BATH FITTER (BATHTUB SOLUTION)
11747 NE SUMNER
PORTLAND, OR 97220
PHONE: 503 - 595 -8827
FAX: 503 - 595 -6051
Type of Use: SF
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
n1✓ /1 cT/c
Call 503.639.4176 by 7:00 a.m. for an inspection that business day.
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.
FROM :BATH FITTER PORTLAND FAX 0. :503 595 -6051 Aug. 05 2009 09:06AM P1
Plumbineermit Apulica�i EC
E .i
Building Fixtures AUG 0 5 2009 I Ou 01.1:1(1,: t .. is ()NIA
City of Tigard Raeeiv,a ���
Da i0 Permit No 0
t312S SW Hpll Blvd., Tigard, OR (OF TIGARD /I, D �,a PUy. r / / o?/
(l Phone: 503,639.4171 Fax: S 'pltu: Review
Lts tion Line: 503.639.4175 D U1� G DIVISION pMGB OilierPmenNo
F I t ; n r F> Pntc Reedy /By; • - -"'
Internet: www.tigard- or.gov Noti S 'per Page I I nr
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'�I {: I" g N j '� ° +� j' i'1' t�l i N� Ne�:cllnr,, �Iq �,1 '(i ..I 'v, µ� lm: ;:- . f �.. -t � �>• � "tNallatll insinuation
I!f5!f;i�l!�11tgili i ur ;Rfi�JJ ���r�putt11 i�fh lx:, 1 �, 1 L �{�ps }.:,�p{��.,RG •'1 p1 ; r +..:•:,i' Y, :- _ .4,...' h{ §kk ,. 10:is'. 1I i . i�:l .frlWµty n ll n la ,{ l il;;�a ` .•y y 1�.lg v id ry 1l y ti`t t C y 14! (. ' ' :.. ,> , , r
.h4mF1F 11LN ikW lfl NS WgtV1RtBtlif '; 1�.[., .. . taw.{, - {lidllx i;Ii 715, .. e ,....i 9; - ' . �.. LL f.I titi Wl�l 111 I .. h, ..•- • 1!1 : 1 d
I� lLra >�1' - if., . i a4'�1a1 nll;nid ,v all � . - •- • ,. 1 -; a'_
❑ New construction 0 Demolition For specialInformation use checked.
Addition/alteration/replacement Description I Qty, I En.. Total
,� , � d I ,. , . , 0 Other: New I 2-family dwellings includes 100
1�!7��,'L � i�jgy > +'�nl �j►gnnn, . a +s Ixt;u 1 uatiwu�I[ I f l t � � w ! - B (� K. for each utility connection
1 ��.IhtIIi M �e H ' qtr 7 ' i1 ri `t ' lP �ptANfi {.:hail. i - ' ? .,i.;i "`111, , unIV;`, - f - connection)
'li l ti 1 1 N OfID I±9bHAli n�sll linen- 1 d . ! "a;'r :1K ; i ; i ,, h:c' "!' • (I) b
1 . , 1 VIII I t4At ii... bath .... 249 20
i 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building Multi- family SFR (3) bat 399.00 -
0 Master builder 0 Other:
Each additional bath/kitchen 45.00 ~
qqh I ita 1{ `fir :vm r!ac a t t sly Fire sprinkler
�H1'?I(�Y�i,!Ilfif'il lRik�'w i }�•1 iltn. to 1'�' 1, w ti ,,,... ,1 sq. (l.) Page Z
e 1 > I t 1 yJ, ii�4i! iliellMlt9ifnR� '��e4 >I�t��illfHt[11�f{V1l k � p j� � (,l I : : j' �� 1. u�5�i >' ^:liii' Site utilities
Job site address: I ()VI 5 !iV1 tR•a.z.V S -4' Catch basin or area drain 16.60
City/State/ZIP: - 1, i. r llc - `.. O'(1... 9 -} •Z 5 _ IAywcll, leach line, or trench drain 16.60 - _
Suite/bldgJapt. no.: Project name: Footing drain (no, linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 l l
- Manholes 1
-
Rain drain connector 16.60
` Sanitary sewer (no. linear n.: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I,ot Ito,: Water service (no. linear f .: _ Page 2
-' Fixture or item
Tax map/parcel no.: ,
> F ' 'i • ? „ - 1 % iw l " + '1 1!14 RU71 T fG> ts re A . 1, [ , .. ,
Absorption valve 16.60
, I� i Hi ,6 i( ; i ti'( t �1' rtf r' �if r ' � it t 0.i' ' N! ii i l tlitii;Itir1)i t` t$:,i ii�:lli I d T T
tz --' .1 l I li lh 1 d i t ( r . 6 , . - Iv x ': i 1, , l 11 �oi 2
1 nt ti ',11. h..1al > - . ,a Idldlli✓ J1 44i�llvl ` nitlaia4,wa��i�rirA �iR�lf , rchm = 1 ; 1 :c,it. , + +': �'I:ifai, tt'::'r :_.116;1 �
L -k,.s , : +'.;:,t Hxcl(tlow prevenler Page 2
'1 ,k, ,. , 1' .- D 5 , t.L.1 of , (,an 5, ,A -- Backwater valve .. ^ T 16.60
Clothes washer 16,60
_ Dishwasher 16.60
f(,}.�,r i ;i 1' f,j th fdlil, ,.1u rte {l IA!{1�l (I I, crs 1,.: 1 .. ,;. ... -.. D r i n ki ng f ountain
1 . ui t l 4 , til:ir.r .�+ nnl: '.•..... 1 G.C,0
1 l , �Ut 1 ! ii ;,, , i i ),: N • .. d } i t 1 ' > �z" ,r 1 a . i i [ hill , ., , ' i- :, iri n,i>I . I-' ,, . .• �. 1 :I .,,.�,�� , 7•Il ! -," ' • r •
}`r e. Y�',l : o( un.l���±�. .i,r�:+��1+1 l In>(1J�}ei�e�triil4 t 1 � - ' ... , ..•..."---
i. ::..I- 1•�...,;:....' is , ,r:..i„ i':
' Ejeclor>;/sump 16.60
Name: 3P..4 C _ ,&) LScel .. -...
Expansion tank 16.60
Address: 1 L� Z ; 5 w / R r ja: 1.t °i +' • Fixture/sewer cap _ 16.60
City/State/ZIP: i • 6I/.. el .; L. -L.3 . Floor druin/ftoor sink/hub 16.60
Phone: ( 1 ( 1 ..c 1 -3 Fox: ( ) y Garbage disposal —. 16.60
iI N l 1t'(I� h {�> i IIll` , x lj ! l d {! i ( I ..r I I I t ! I , t i , I tlP1` , L f Ip IRRAi >rto li 1 Hose bib
1 >1 , t . h r ( [ ` h i; t ! I1 1 11 1' 1 @ w Y 7-.. ...MITI 111 16.60
1 i1M:.l t1;li ii ali iliii',flit if niLa3 rsnu.nlii111',ii �ati i III , i ',' ., °I+li'.a i,l ri . I +' Itt �eliiift ' t f i2 kt l ' i + - 16.60
Business name: (( ! ice maker -`
I� c'1(� 1 ��~ l P i .. .. Interceptor /grcaso trap 16.60
Contact name: c� l t) c0 <, (k (,� _ ^ Medical gas (value: $ ) Huge 2
Address: i� -i- ►.( N ;. ., • • , . r Primer T
Li
City /Stute/ZIP: r � � 0I4- (� 2 Z �� - -... Roof drain (commercial) W 16.60
16._60
Phone: Sink/businAavatory 16.60
( �i'3) 5 Y Is 157 1 Fax:: 6 ) S .'r ; 7 6�� / —
Tub /shower /shower pan ) 16.(;0 y
E-mail: a A tki "(kAQ 4,t.el f GJi . a,ti, _ Urinal ( (U,f, _
f a�wj' ?i ,2
1l p�t�k 1y o ay ; mt. nn:r,.;': 16.60
11A � r t I i ,' N , ! i , f1 A ' .. 1 1:iy . : jij i V!i 64iiiiq e.!''I fi ^f::::: ?: i'
i
i 1, 1' ?:1�.11Va .CC!111i I14,7id' �1 �� + I . .. e}i %! 4 {i �I1 "i' '1! .`3.7 ; ::n1:! .i , :i l
NIA {i ' . A�1 djlli GI '{ �iliy j: n �3dY+:4l� er i;ile; ,��:� nfl: �:_ Water closet 16.60
Business name: 11.)(A-j (,l ( { - Water heater 1
Address: W t 13 (d 1 N i- ,5 l%M .. Omer; __ .
City/Statc /111 t? ;, i -} n „ 1 i a a_ 11- � , Subtotal ..._
Phone: ( - li S' 6 15 $1 1 .4' Fax: (: ) S `1� 5- ( n 0, Minimum permit fee: $36.20 7a 1 50
- ( Residential hacktlow minimum permit fee: $36.25
CCB Lie,: 1( Plumbing L P
9 . .4 elq I' Plbiic. no.: '3 :; l y f f _ Plan review (25% of permit fee) _
Authorized signature: C -'L-----\ i I ( � Slate surcharge (12% of permit tie) 8 ` -70
}� TOTAL PN.KMIT FEE D h AO Print name: .. G1 , 1 l f' (• lr✓ Dute: �_ - _ )') This permit application expires if a permit Is not obtained within
ISII days after it has been accepted as complete.
°Fee methodology set by Tri- County Building Industry Service Board,
MundfnOarairo1PLMP- acnnUApp.doo IL27/06 44o- 4R16T(10/02/C(IM/WEB)