Permit CITY OF TIGARD PLUMBING PERMIT
III
a • COMMUNITY DEVELOPMENT Permit ft: PLM2016-00192
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/11/2016
T t c;A A 1) 9 Parcel: 1S134DA09100
Jurisdiction: Tigard
Site address: 11380 SW THUNDER TER
Project: Wallace Subdivision: DAKOTA MEADOWS Lot: 24
Project Description: Replace shower pan
Contractor: FIVE STAR PLUMBERS INC Owner: WALLACE, JAMES L&ANNE E
PO BOX 28 13500 SW PACIFIC HWY STE 58#237
BANKS, OR 97106 TIGARD, OR 97223
PHONE: 503-324-0717 PHONE:
FAX: 503-324-0883
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 04/11/2016 $12.51
Specifics: 1 12%State Surcharge- 04/11/2016 $8.70
Plumbing
60 ea Minimum Fee Adjustment- 04/11/2016 $59.99
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: ,�$ignature:(4gorr.goet_____
.
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.
From: n 04/08/2016 08:53 #041 P.002/002
Plumbing Permit ApplicatiREC'E�VED
Building Fixtures pPR 1 1 2016
Received _
City SW lYate/By: 9 // /� Permit No/OL�y e2d/92
it III
13125 SW Hall Blvd.,Tigard,OR 9 OF TAS. _ plan Review 'l�O`�
Phone: 503.718.2439 Fax: 503.5� ] AA'' �/ n fhtelBy: Other Permit No.:
Inspection Line: 503.639.4175 Bial �l`f� U I '��®" pate ReadyrBy, Jars: See Page 2 fur
1 l(..ARD
Internet: www.tigard-or.gov Notifred:Mclhod: Supplemental Information
TYPE OF"WORK FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist.
Description I Qty. L Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 tt.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath , 312.70
® I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
D Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11380 SW Thunder Terrace Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Wallace 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 ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New shower pan
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
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
0 APPLICANT .® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Susan Lass Interiors Medical gas(value:S ) Page 2
Primer 12.51
Contact name:Susan Lass
Roof drain(commercial) 12.51
Address:12510 SW McAlpin Place Sink/basin/lavatory 25.02
City/State/ZIP:Beaverton,OR 97007 Solar units(potable water) 62.54
Phone:(503)550-9882 Fax::( ) Tub/shower/shower pan 1 12.51 12.51
E-mail:sue.m.lassgmail.com Urinal 25.02
G
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Five Star Plumbers,Inc. Water piping/DWV 56.29
Address:PO Box 28 Other: 25.02
City/State/ZIP:Banks,OR 97106 Subtotal 12.51
Phone:(503)324-0717 Fax:(503)324-0883 Minimum permit fee: 572.50 72.50
CCB Lie.:169703 '✓ Plumbing Lic.no.:PB108 7 Plan review (25%ofpermit fee)
State surcharge(12%of permit fee) 8:211._
Authorized signature: XA---- TOTAL PERMIT FEE 81.20 1
It 1 This permit application expires if a perish is not obtained withi -
Print name:Jeff Parson Date:04/08/16 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:Building'Permits,P1,M11-remtit.App.doc 1001'09 440-4616T(10'02 COM WG6)
From: 04/08/2016 08:53 #041 P.001/002
FIVE STARri / Sc-J 72-11-ofc-e-,,cv-
* * * * *
PLUMBERS
FACSIMILE TRANSMITTAL SHEET
TO` FROM:
Permitting Angela Strauss
COMPANY: DATE:
City of Tigard 04/08/16
FAX NUAfMER: 'F(YCAl.NO.01-PAGES INCLUDING(:OVER:
1:111) ,, 2
PI ION l-NUN1BE-R: SENDER'S 121..FERI{NCIi NUMI1I.R:
RE: YOUR REFERENCE NUMBER:
Plumbing Permit
0 URGENT 0 FOR REVIEW 0 PLEASE COMMENT 0 PLEASE REPLY 0 PLEASE RECYCLE
NOTES/COMMENTS:
Please see attached plumbing permit applicatioin. We were hoping to schedule the inspection for
Monday but it seems your office is not open today. Can you please contact Sue Lass on Monday to
set up the inspection as I will be out of the office next week.
Thank you!
Contact Info:
Ph: 503-550-9882
Email: sue.m.lass(a�gmail.com
P.O.Box 28,Banks,OR 97106 * Phone:(503)324-0717, Fax(503)324-0883 * CCB# 169703
LICENSED • BONDED • INSURED
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11380 SW THUNDER TER, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00192
Don Sylvester
Violation Summary:
Inspector Contractor