Permit CITY OF TIGARD PLUMBING PERMIT
II a • COMMUNITY DEVELOPMENT Permit #: PLM2009 -00145
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 06/11/2009
Parcel: 1S134CD09200
Jurisdiction: Tigard
Site address 11645_SW TIGARD -DR/
Subdivision: Lot: 0
Project: Torres
Project Description: Install (2) lays, (1) tub /shower, and (1) w /c.
Owner: FEES
TORRES, NANCY Quantity Description Date Amount
11645 SW TIGARD DR
TIGARD, OR 97223 2 ea Lavatories 06/11/2009 $33.20
PHONE: 1 ea Tub /Shower /Shower Pan 06/11/2009 $16.60
1 ea Water Closet 06/11/2009 $16.60
1 12% State Surcharge - 06/11/2009 $8.70
Contractor: Plumbing
LIBERTY PLUMBING 6 ea Minimum Fee Adjustment - 06/11/2009 $6.10
Plumbing
19363 WILLAMETTE DRIVE #232
WEST LINN, OR 97068
PHONE: 503 - 888 -8830
FAX' 503 - 699 -7630
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: C tr � (j „ n )\ Permittee Signature: •
Call 503.639.4175 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.
Building Fixtures - RECEIVED •
Plumbing wit Application , �; c
JUN 1 Ag09 Received pennitNo.pL 1v12r4• • te e)
. City of Tigard Daodve
13125 SW Hall Dritt Te. OR 97223 CITY 0 ,4 I Plan Review Other Permit No.: Phone: 503,83041/i. 103.598.1960 BUILDI■ `K
24- Hour Ittlfieo6m EE 503.639.4175 1 , • i. I Date Ready/BY , t ® See page 2 for
Internet www.citigard.or.us Supplemental Information
Ord .us N°tifi -._-_. Lod r £=. _
'+' - " '" ^�, For special iwforaa use checkl
❑ New caOSifUO�®@ ❑ Demolition For I Qty. I Ea I Total
■. Additioo/dtechdOhOplacement ❑ Other: New 1- 2- faintly dwellings (includes 100 R far each uti connection)
: -a
_ . a m •.. as r j , I 24920 l i
;� _ c .- i •r .., F : =- . - c SFR (1) bath I tl
� - -- ` ❑ Commaria ndustrial SFR (2) bath 350.00
J�1 - and 2- taauly dwelling 399.00
• - SFR (3) bath
❑ Accessory building ❑Multi fatally Each additional batb/kitehen 45.00
❑ Master builder ❑ Other F (__ sq. R) Page 2
:.sw ims:- sue• -vyK� rr -- 5' -- .+r`�- r .. ...,-
- `_- :;Y- - .•r 3 ::: _. .4;::. '''f.. . :-a- �.t. .?`S-'.. xr v-. S1tentllidee
Job site address: jilt Y J Sv,) c r ...C.4=-01: Catch basin or area drain 16.60 •
City/State/ZIP: l 41rn " rci �� p (L q"1223 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft: _� Page 2
Suite/bldg./apt no.: Project name: ft?� Manufactured home utilities 110.00
Cross street/directions to job site: Co55 • Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft: _) • Page 2
Storm sewer (no. linear R: _) Page 2
Water service (no. linear ft.: _-_ ) Page 2
Subdivision: I Lot no.:
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
^ T ; . _` * � „I- .` -. Backfow preventer Page 2
1 1 3 1N. 4 L r b o el.— M ilr d cLQ -L �' Badcwat a valve 16.60
Clothes washer 16.60
Dishwasher 16.60
g 16.60
�-. o r s 3 A' ' ".` s ; . ' - -- - ' -"' -. Eject rs/sutmp 16.60
Name: `` sea 'i c r d • __0,n Expansion tank 16.60
I G_
Address. -n- „ r d r 0 e. at Fixtu e/sewer cap 16.60
� + rd,. 0 ,e • q 7 ? , Floor drain/floor sinlc/hub 16.60
City/State/ZIP: ( � i"�-
gep �l 16.60
Phone: �/ Fax: ( ) 16.60
3 ) S �,� � n Hose bib
.t -.eras - eA > wwL - .� __
._...,�. rt ice maker
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: T ) Page 2
Primer 16.60
Address: � .
Roof drain (commercial) 16.60
Ciry /StateIZZIP: Sink/basin/lavatory 1,.... 16.60 '3 t
Phone: ( ) I Fax ' ( ) Tub/shower/shower pan I 1 Lie. (o t)
E -mail: Urinal 16.60
N - ° - � ' a 5 .2- ' s c - '-- T` — . :-2`. a - Water closet 1 16.60 Ito, BT)
Business name : L 1 t Water heater - 16.60
� .,
�
Address: L L t 2 4 N M ', ` 3� ° u Subtotal We MO
City/State/ZIP: pp A -1 o � 'r Minimum permit fee: 572 -50
Phone: (,W g0 G ` 2Z � Residential bad�ow minimum permit fee: 5362 � 5 12 50
d s3 Zi � Fax: ( 3) 2-53- 43
CCB Lic.: t b Plumbin Lic no.: 43 Pn � Plan review (25% of permit fee)
� ` � ' 1 ` \a 7; State surcharBe•(8°Yb 11T�Permit fee)
Authorized signature: 9 — ` �� t l TOTAL PERMIT FEE EI
Print name: 1/1n O• t • er This permit application expires if a permit is not obtained with i
180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Boa