Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00384
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2013
Parcel: 1S 134ACO2646
Jurisdiction: Tigard
Site address: 11040 SW COTTONWOOD LN
Project: SWEARINGEN Subdivision: ENGLEWOOD NO.3 Lot: 212
Project Description: Replacing tub,water closet&lay for hall bathroom remodel
Contractor: POWER PLUMBING CO Owner: SWEARINGEN, LARRY
PO BOX 19418 ROBERTA
PORTLAND, OR 97280 11040 SW COTTONWOOD LN
TIGARD,OR 97223
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Lavatories 10/28/2013 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 10/28/2013 $12.51
1 ea Water Closet 10/28/2013 $25.02
Type of Use: SF 1 12%State Surcharge- 10/28/2013 $8.70
Class of Work: ALT Plumbing
Type of Const: • 10 ea Minimum Fee Adjustment- 10/28/2013 $9.95
Occupancy Grp: Plumbing
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 503.232.1987 or 1.800.332.2344.
Issued By:
CD / e 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.
•
OCT/24/2013/THU 01 : 20 PM POURER PLUMBING FAX No, 503 244 8825 P. 001
Plumbing Permit ApplicatiAnCEIVE.D
Building Fixtures 1.0K OFFICE USE (J L\
City of Tigard OCT 2 4 2013 l0 6t• 3 C& PennitN°•: /at/490/3'60 3fr4/
13125 SW Hall Blvd,Tigard 7 y
! Phone: 503.7182439 Prot 8_ TIGARD Date/By: Other Permit No.: eke Ana tblp4/a
j Inspection Line: 503.63 . UILDIN DatcReady/By: brit Ib See Page 2for
Z'i •�u l Internet tvww.tigard-or.g� l G Div! 1 ► Notified/Method; Su•.lemeotal lnformadon
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1::',A (, t i +�,,;: Fl.:. _.:+11.__..?ne ?' �itv.. uT,i,.tJw_�'}�.vtu..44,:xx,+ � .:a2Y� �E:.§i�.vkr.•�K_.�re.'S�lr f.5+..3N:! ,r .._�J ... �_e . . +„i4n 5V.tirr_::
❑New construction ❑Demolition
For .edal In o,7nmtorr use dreckbist
Descri,don •‘. Ea. Total
►:Addhion/alteration/replacement ❑Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
w� r \n uul in/ rrJn).lhn u innl`n - vl y SFR 312.70
,_t , ,-. ... .1..v_
X1-and 2�farnily dwelling l=1 Commercial/mdusttia) SFR(2)bath 437.78
SFR(3)bath 50032
❑Accessory building ❑Multi-family
-. Each additional bath/kitchen 25.02
❑Master budder ❑Other Fire sprinkler( sq.ft) Page 2
r lif 1r+�9?��YtMt�4 l xy iL u?:r�
If, r -, it .,Hill'-1s`fi Vin, :,p1'lifIO .Cil I rfn(cn�;ryraa } 4t u't N,,fy, ,f! Site utilities:
Job Site address: 11 0,146 50 CO N WO OX- 1 a /V Catch basin or area drain 18.76
�) ,,,,d DYE q 711 Drywall,leach line,or trench drain 18.76
City/State/ZIP:
Footins drain(no,liacar ft.: Page 2
Suite/bldgJapt.no.: - I Project name: 5LO6A6 et Manufactured home utilities 50.03 _
Cross street/directions to job Site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear it: ) Page 2
• Water service(no,linear ft.: Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Eaekflow preventer 31.27
zt, iry� F e.,,.._ 3 Backwater valve 12.51
'_1 .,;;_,__�.,,,:.r :•• --=--,7-. .___.1., -I/ _Clothes washer 25.02
! •/ , f'? •r, • C. I- ,/ 1/ Dishwasher 25.02
Drinking fhuntain 25.02
- LL 6-79-77-/-72,00 I1 /2.t l7p b U.. Ejectors/sump • 25.02
` -`. f�l�I 1 ) ti� ' ;r. ��. 1. S'y s U_-
EpansiOntank 12.51
Fixturdsawer cap 25.02
Name: - Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
1 City/State/ZIP: Hose bib 25.02
I -
i Phone ( ) Fax ( ) Ice maker 12.51
, • 1i "17lln:FC7i S:i:i1i-L' t_. ,Z11". il."j.4`61s,�'.r�t it l`ri r J 3 '•, Interceptor/grease trap 25.02 -
Medical gas(value:$ ) Page 2
Business name: PD u,.1 Q (r I pi t. 44.b I.IA el 611 . Primer 1251
Contact name: c-fo t I ei ti 1 I /I.e. Roof drain(commercial) 12.51
Address: 0 LP// 5µI /1 OA • a VaL Sink/basi lavatory j 25.02 ZS./.)27
I City/State/ZIP: /)//7GZ.A4 " / ` 7Z1 Solar units(potable water) 62.54
Phone:( ).22 L(L.f /L/`D(J Fax.:(5 03)2 yw_&g2 Tukhower/shower pan 12.51 I?..S
I E-mail: KO'Stine V ' ktie/ l uvn b,tt eio Ld rd4.- Urinal 25.02 �1 r �7
I 1_ -_ ,5 ,tii,r ..f I Yl---fir cz. v[ v-,Y'T4;r4+i:9. +w I s0,,Vctf ..3. m i`s-' Water and I 25.02 sl7.0 .-
r Ji, v+ r t l r.V`2 l r l.4,2{n r x f i ':h4 r r xµf 'v
+.- .a.+.> t--,,<. ! .�._: ....::,v • Sly«^Zr .nt ..,.V.....Iy..]- wow heater 37.52
JBusiness name: rd/�(,LQ_- //u h/NI, a . _ Water piping/DWV r 56.29
eAdder: Pty ! / . it Other: 25.02
City/State/ZIP: Ut ,e/ eic 172 Subtotal (p7,C!
Minimum permit fee: $72.50 .
Phone:(51)3) ZG1W-1 GlDd Fax:( j) L�U/_ zs 7 Z
�� /�p Plan review (25%of permit f8e) 1
CCB Lie.: Plumbing Lie.no.: e
SZ _ State surcharge(12%of permit fee) g.7 d
Authorized signature: ....2, ---------•-.7,..1-
TOTAL PERMIT FEE nap
Date: /d/Z This permit application expires if a permit is not obtained within 180 days
Print name: ��� ��� / after it has been accepted as complete.
+Fee methodology set by'fri-County Building Industry Service Board.
b∎Bniktleg1 ennite •MU-PermaApp.doc IWOI/09 445-4616T(t0/07JCOM/WEa)