Permit n CITY OF TIGARD PLUMBING PERMIT
111 g , COMMUNITY DEVELOPMENT Permit #: PLM2013 -00146
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2013
Parcel: 1 S 134AD04600
Jurisdiction: Tigard
Site address: 10705 SW BLACK DIAMOND WAY
Project: Janssen Subdivision: BLACK BULL PARK Lot: 33
Project Description: (1) tub /shower replacement
Contractor: B AYRES PLUMBING & CONTRACTING INC Owner: JANSSEN, RONALD H AND
PO BOX 149 ROBERTA M
CANBY, OR 97013 10705 SW BLACK DIAMOND WAY
TIGARD, OR 97223
PHONE: 503 - 266 -5955 PHONE:
FAX: 503 - 266 -5957
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 05/09/2013 $12 51
Specifics: 1 12% State Surcharge - 05/09/2013 $8 70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 05/09/2013 $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 or 1.800.332.2344. // f
Issued By: 6 11 4„ 7 Permittee Signature: O I `
/C `H_I (GIJL
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.
05/12/2011 00:49 5032665955 TRISTA PAGE 02/02
Plumbing Permit ApplicatiQu EIVED
Building Fixtures t OR O I I l c i s I ti t' t >.1.1
City of Tigard/ 0 9 2013 Received
s q `( 1 13 sr ,Peneit No.: PL.Lt c> 1 0 , 3 - 00 I
• 13125 SW Hall Blvd., Tigard, OR 97223 �1
Date/By:
Phone: 503.7182439 Fax: 503.598d4dOX OF TIGARD Rats R yV ew Other Permit No.:
1 . i `. ,\ i s l 1 Inspection Line: 503.639.4175 • t 1( I .1) I NG DIVISION Date Ready/By: -sib H See Page 2 fur
Internet www.tigard.or.gov Notified/Method: I l Supplemental Information
❑ New construction ❑ Demolition For t� jotmrulan use checklist
Description j Qty. l Ea- 1 Total
ddition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft fbr each utility connection)
SFR (1) bath 312.70
9P1- and 2-t'hmily dwelling ❑ Commercial/ industrial SFR (2) bath 437.78
O Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2
Site utilities:
Job site address_ `Crley ,� ba 13 � ( ) Catch basin or area Grain 18.76
City/Siate/ZZIP: 5g, Dryweil, leach line, or trench drain 18.76
Footing drain (no. linear IL: _) Page 2
Suite/bidgJapt no.: I Project name: Ivlanufactured borne utilities 50.03
Cross street/directions to job site: Manholes 18.76
D J . 1 1 f \ \ "c Rain drain connector 18.76
Sanitary sewer (no. linear ft: _j Page 2
Stoma sewer (no. linear ft: ) I Page 2
Water service (no- linear R.: ) I Page 2
Subdivision: I Lot no.: Fixture or item: _
Tax map /parcel no.: Bacldlow preventer 31.27
12.51
: Backwater valvo
... ,- • • _ _ . ..... Clothes washer 25.02
tek-ACk � Q ` LX t Dishwasher 25.02
l )( \.\� Drinking fbuntain 25.02
Pjectors/sump 25.02
Expansion tank 12.51
Name: Fixture/sewer cap 25.02
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
Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name: Primer 12.51
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /StatelZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax:: ( ) Tub /shower/shower pm 1 12.51 (1 51
E-mail: Urinal 25.02
MilM11111111111111111/1111111.111111111 Water closet 25.02
Water heater 37.52
Business name: Q [ -eY ` / \ '�\ Water piping/DWV 56.29
'
Address: ( C" � • \U 1 Other: 25.02
City/State/ZIP: ' ( ( \ \ 41 ,, \ OR, C,\ Subtotal 17
Phone: )'ip pip c7 Fax: (aZ)a as.,:yi Minimum permit fee: $72.50 "7.0
CCB Lic.: `--' ' 5 Plumbing Lie. no.: Plan review (2590 of permit fee)
State surcharge (I2% of permit fee)
Authorized signature: C TOTAL PERMIT FEE \!
Thla permit application expires a • permit Is not obtained within 180 clays
Print name: ,� `� Data: G} I I after it has been accepted as complete.
�� - ■ ' `� "Fee methodology set by 1ti- County Building Industry Service Board.
I: 1Build ing1PmmiiPLMU- PermitAppdot 10/01/09 44eA616700/COCOMA9RB)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10705 SW BLACK DIAMOND WAY, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
2013-10-29 (null)
PLM2013-00146
PASS - No C of O
Janssenrr@msn.com
Violation Summary:
Inspector Contractor