Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2014-00021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2014
Parcel: 25111 CC21300
Jurisdiction: Tigard
Site address: 10250 SW GREENLEAF TER
Project: Nielson Subdivision: SUMMERFIELD NO.5 Lot: 271
Project Description: Replace tub/shower valve and tub.
Contractor: AAPPLE PLUMBING Owner: KEN NIELSON
PO BOX 1543 10250 SW GREENLEAF TER
HILLSBORO,OR 97123 TIGARD,OR 97224
PHONE: 503-648-1855
PHONE:
FAX: 503-647-2736
FEES
Quantity Description Date Amount
ea Tub/Shower/Shower Pan 01/22/2014 $12.51
Specifics: 1 12%State Surcharge- 01/22/2014 $8.70
Plumbing
Type of Use SF B0 ea Minimum Fee Adjustment- 01/22/2014 $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 que •ns • •UNC b calling 503.232.1987 or 1.800.332.2344.
Issued ;y: 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 Applicati CEIVEp
Site Utilities t((LL 1 FOR OFFICE USE ONLY
City of Tigard Received Permit N,
_ -+ 13125 SW Hall Blvd.,Tigard,OR 9•d>�N 2 2 2014 Dates Review
//� A,...„..,/,) Lf`"/ / L "`
Phone: 503.718.2439 Fax: 503.598.1960 Darby. Other Permit No.:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juis: B See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE oFittpING DIVISION FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. 1 Ea. 1 Total
yr Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath I 312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath _ 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
/0 2 5-O 5 i u, 6 rren I f� r r Catch basin or area drain 1 8.76
Job site address: -}'
City/State/ZIP: �-..�1 Drywell,leach line,or trench drain 18.76
ty 1 1 5!�.rd t^�-' } Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: N(E L 54.V Manufactured home utilities 50.03
Cross street/directions to job site: ( j� Manholes 18.76
f l Ai-(�u h� `-)-d',I/0,..v.on.er-C;o'l I Or Rain drain connector 18.76
�J -t! 6 r,��s f 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
� �//� L _ Clothes washer 25.02
r�1 J�L- l `-r 6 4- filth:if{ a, (op fit.yA Dishwasher 25.02
. 1∎41 Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: 0 I E L6C 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
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
-
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) I Fax::( ) Tub/shower/shower pan 1 12.51 «_57
E-mail Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: al I e- Pi 6 l!? 'AC . Water P tP in WV 56.29
P�
Address: f , (, /x I S q 3 Other: 25.02
City/State/ZIP: Hi' II c J 0rci Subtotal
Phone:(505) (1 Lf J-_ /6 55" Fax:( ) Minimum permit fee: S72.50 7x_577
CCB Lie.: L 0 1y 3/ / Plumbing Lic.no.: 3y-30&p6 Plan review (25°/s of permit fee)
f State surcharge(12%of permit fee) g. 7D
Authorized signature:fl �� /7/e State
PERMIT FEE
AI -v
Print name: - ( F C g (_ Date: /, Z.Z.r/L/ 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
I-.\BuildingVormits\PLMU-Perm¢App.doc 10/01/09 4404616T(10/02/COM/WFB)