Permit CITY OF TIGARD PLUMBING PERMIT
I/ COMMUNITY DEVELOPMENT Permit #: PLM2013 -00160
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/29/2013
Parcel: 2S 111 AB03800
Jurisdiction: Tigard
Site address: 9205 SW VIEW TER
Project: Zadow Subdivision: PENMAR TERRACE Lot: 10
Project Description: Two bathroom remodels and (1) new hose bib.
Contractor: PRO SOURCE PLUMBING LLC Owner: ZADOW, MARK D & DIANE S
980 SE SACHA PLACE 9205 SW VIEW TER
HILLSBORO, OR 97123 TIGARD, OR 97224
PHONE: 503 - 348 -2695
HONE: 503 - 936 -7784
FAX:
FEES
Quantity Description Date Amount
1 ea Hose Bib 05/29/2013 $25.02
Specifics: 2 ea Lavatories 05/29/2013 $50.04
2 ea Tub /Shower /Shower Pan 05/29/2013 $25.02
Type of Use: SF 2 ea Water Closet 05/29/2013 $50.04
Class of Work: ALT 1 12% State Surcharge - 05/29/2013 $18.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $168.13
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. Alt 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 • - enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or ect questions to • NC b .fling 503.232.1987 or 1.800.332.2344.
Is ued By: .� Permittes 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 Applicati ECEIVED
Site Utilities FOR OFFICE USE ONLY
MAY 2 9 2013 R eceived
III - City of Tigard Permit No_:
13125 SW Hall Blvd., Tigard, OR 9�OFTIGARD Datem : 5 _�
l ao /��do /!a0
Plan Review
Phone: 503.718.2439 Fax: 503.5 Other Permit No.:
T I G A RD Inspection Line: 503.639 BUILDING DIVISIO D ate m y: Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: I Supplemental information
TYPE OF WORK 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
® I- 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 site address: 9205 SW View Terrace Catch basin or area drain 18.76
City /State/ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Zaddow Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Metro license # 10374 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: 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
two bathroom remodels and hose bibb
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Mark and Diane Zaddov■ Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State/ZIP: Hose bib 1 25.02 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: Pro - Source Plumbing , LL( Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roy Craig
Roof drain (commercial) 12.51
Address: 980 SE Sacha Place Sink/basin/lavatory 2 25.02 50.04
City /State /ZIP: Hillsboro, OR 97123 Solar units (potable water) 62.54 ` y
Phone: (503) 9367784 Fax: : (503) 4305737 Tub /shower /shower pan 2 12.51 X? . .$0 it
E -mail: prosourceplumbingllc @yahoo.com Urinal 25.02
Water closet 2 25.02 50.04
CONTRACTOR
Water heater 37.52
Business name:
Water piping/DWV 56.29
Address: Other: 25.02 1
City /State/ZIP: Subtotal l� .gler i 4
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: 188802 /11 l l tr Plan review (25% of permit fee)
4 1 t� Plumbing L ic. no.: P 6795 '� t
State surcharge (12% of permit fee) ii e
Authorized signature: P TOTAL PERMIT FEE j (p9' . 6
I Print name Roy Craig Date: 5/10/13 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(IO/02/COM/WEB)