Permit •
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CITY OF TIGARD- PLUMBING PERMIT - -
° COMMUNITY DEVELOPMENT `) Permit#: PLM2012 -00310
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Date Issued: 10/25/2012
!! • /3"/ Parcel: 2S104CD06900
Jurisdiction: Tigard'
Site address: 13599 SW BRIM PL
Project: Nyberg Subdivision: HILLSHIRE ESTATES . 'Lot: 69 '
Project Description: Replace tile shower with new shower pan and valve. 11/13/12 Adding 1 tub to permit. REPRINT for additional tub ,
Contractor: ANSPACH PLUMBING INC Owner: NYBERG, CLEVE F & DEBRA A
18380 S FERGUSON RD 13599 SW BRIM PLACE
OREGON CITY, OR 97045 TIGARD, OR 97223
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' PHONE: 503- 789 -3913
PHONE: 503 - 793 -2310
FAX: 503 - 631 -7972
FEES • ,
Quantity Description - Date Amount
ea Tub /Shower /Shower Pan 10/25/2012 $12.51
Specifics: 1 12% State Surcharge - 10/25/2012 . ,$8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 10/25/2012 $59.99
Plumbing •
Class of Work: ALT 1 ea Tub /Shower /Shower Pan 11/13/2012 $12.51
Type of Const:
Occupancy Grp:
Stories:
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•
Total $93.71
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: J Permittee Signature: e
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
° rz COMMUNITY DEVELOPMENT Permit #: PLM2012 00310
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
Parcel: 2S 104C D06900
Jurisdiction: Tigard
Site address: 13599 SW BRIM PL
Project: Nyberg Subdivision: HILLSHIRE ESTATES Lot: 69
Project Description: Replace tile shower with new shower pan and valve.
Contractor: ANSPACH PLUMBING INC Owner: NYBERG, CLEVE F & DEBRA A
18380 S FERGUSON RD 13599 SW BRIM PLACE
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-789-3913 PHONE: 503 - 793 -2310
FAX: 503 - 631 -7972
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 10/25/2012 $12.51
Specifics: 1 12% State Surcharge - 10/25/2012 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 10/25/2012 $59.99
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 Notifi - •n 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 dire •uestions t• •UNC by calling 503.232.1987 or 1.800.332.2344.
B y . , 001 / / Permittee Signature:
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.
Plumbing Permit Application
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' Building Fixtures - CEIVED FOR OFFICE USE ONLY
- City of Tigard DaaeBy /D € 5" • / Permit No.: iraaeja_‘61 ,5/6
a 13125 SW Hall Blvd., Tigard, OR 97223
, - . Plan Review
0 : Phone: 503.718.2439 Fax: 503.598.19 T 2 5 20:7 DateBy: . Other Permit No.:
Inspection Line: 503.639.4175 Date Read B Juris: ®See Pa e
TI Ready /By: g . 2 for
Internet: w ww.tigard - or.gov C N o t ified/Method: Supplemental Information
TYPE OF wailliILDING DIVISION FEE* SCHEDULE
❑ New construction • ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
• SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job address: 3 s� ? 51A/ •3 k IM P`,, Catch basin or area drain 18.76
City / State/ZIP: T l 6 4 go U r` q 7 2- 3 Drywell, leach line, or trench drain 18.76
/ Footing drain (no. linear ft.: . ) Page 2
Suite/bldg. /apt. no.: I Project name: A) N/ (.e.2 6 Manufactured home utilities 50.03 .
Cross street/directions to job site: S.i,'t ( . eNc,F}- 1 e t) T o 5 IA) Manholes - 18.76
i3 i M p L Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: N I L L SHIP-C__ I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
TeAr� OUT e-M(STit 6 ti be 5 k /40 0 Dishwasher 25.02
/U tVl/ S t UW C 12 P A-N / U N C. S h. (..A„ U e 12 Drinking fountain 25.02 .
V ALu Re - -r( `e _ Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank ' 12.51
Fixture /sewer cap 25.02
Name :. LL e V e_ .Z- O e- r3(3 (e N`/ A e a 2 G . Floor drain/floor sink/hub 25:02
Address: I 3 s SW 321M 1t! 1 .
Garbage disposal 25.02
City/State/ZIP: -1 i 6,4 1 0.R... cf 7 9-2,3 - Hose bib ' 25.02 '
Phone: (5G 3•) 7 ( 3 .. 23 I O Fax: ( ) Ice maker , . . . 12.51 . •
[ilir APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 ' i
Business name: 7-ac - nn He( cd ' s CACTI 0 /V LL_
Primer 12.51 Medical gas (value: $ ) Page 2 .
et'-t N e I /
Contact name: N ZP Roof drain (commercial) - 12.51
Address: 1 37 .24 S W J e NNq (IT- Sink/basin/lavatory 25.02 '
City/ State/ZIP: . i , • 7 12 Solar units (potable water) 62.54 .
Phone: ( 3) 5 t - 76 24 Fax:: (c03) S 79_ 612-0 Tub /shower /shower pan ( 12.51 /2,57
E -mail: `j S h e, l fJ - L` _' v s N, c o M Urinal 25.02
Water closet 25.02.
CONTRACTOR
P Water heater 37.52
Business name: A 1J PAC N 1' Lu I ISI N Water piping/DWV 56.29
Address: ( '3 a o -f' R G cks o 12.0 Other: 25.02 -
City/State/ZIP: •, €GO N c 0/ 70 LI- c - Subtotal G�
Phone: (S() 3) ' 9' _ 39' 13 Fax: ( ) _ Minimum permit fee: $72.50 7� ;50 '
CCB Lic.: ' 6 3 7. /7 1 Plumbing Lic. no -:�-LI '2 7 r�j
' Plan review (25 % of permit fee)
J / State surcharge (12 %ofpermit fee) 8.74
Authorized signature: / . TOTAL PERMIT FEE g i • 2.b
(� . (e.4 �l Date:
This permit application expires if a permit is not obtained within 180 days
Print name: M,.
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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