Permit (39) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Permit#: PLM2017-00365
Date Issued: 09/07/2017
-f WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S104BA10700
Jurisdiction: Tigard
Site address: 13643 SW LIDEN DR
Project: Teaff Subdivision: CASTLE HILL NO.3 Lot: 137
Project Description: New shower pan and shower valve.
Contractor: LARSEN &SON PLUMBING CO INC Owner: TEAFF, JANET E TRUST
8537 SW 54TH AVE 13643 SW LIDEN DR
PORTLAND, OR 97219 TIGARD, OR 97223
PHONE:
PHONE: 503-246-7004
FAX: 503-246-8336
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 09/07/2017 $12.51
Specifics: 1 12%State Surcharge- 09/07/2017 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 09/07/2017 $59.99
Plumbing
Class of Work: ALT 1 ea Investigation Fee 09/07/2017 $90.00
Type of Const: 1 ea Investigation 12%State 09/07/2017 $10.80
Occupancy Grp: Surcharge
Stories:
Total $182.00
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 Notific. .•• -iter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire .uestions to OU b sy c- '•• 503.232.1987 or 1.800.332.2344.
Iss,ed By: 0 / / Permittee Signature: 77.-el-pc4
P4)-I'l--(-21
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 Per itApplicata KECL�
Building Fixtu es IVEP FOR OFFICE ISE ONLY
City of T gard Received p
Date/B / 7 , / Permit No.: G� Q��/
Ili r 13125 SW H:11 Blvd.,Tigard,OR 97223 E P 0 7 2017 y' �b/T' os
p Phone: 503. 18.2439 Fax: 503. 0,��pp TIGARD
an Other Permit No.: e�rdo,7��3g
Inspection Li e: 503.639.4175 �9 L Date _
7't C n ft D Date Ready/By: Juris: Fd See Page 2 for
Internet: .tigard-or.gov Notified/Method: Supplemental Information
TYPE OF%WING DIVISION FEE* SCHEDULE
For specialInformation use checklist.
❑New construction ❑Demolition
Description I Qty. I Ea. ) Total
gAddition/alteration/repla,ement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
GORY OF CONSTRUCTION SFR(1)bath 312.70
and 2-family dwelling 0 Comercial/industriai SFR(2)bath 437.78
m
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB INFORMATION AND LOCATION- Site utilities:
Job site address: 1 3(p 3 ,j w Li c e v\ IbiP\ve Catch basin or area drain 18.76
City/State/ZIP: 2-'3
Drywell,leach line,or trench drain 18.76
-i-l l�C�Y:► / b Z Z 3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: bpt74 Manufactured home utilities 50.03
Cross street/directions to job.ite: v v 5 j 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: 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
n.UJ 55.6 Wtr , v. A,V1t"... v&\V't; Dishwasher 25.42
Drinking fountain 25.02
Ejectors/sump 25.02
IX PROPERTY e R 0 TENANT Expansion tank 12.51
Name: J o vw f -e Ct.Y� Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
1'{3 $W Lie e.i` .)r iv-e. Garbage disposal 25.02
City/State/ZIP: `j QYA / 6 4i 2-2,3 Hose bib 25.02
Phone:( ) 5-a _ ', •.. Fax:( ) Ice maker
12.51
fgLAPPLICA T 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: ( `�jre� r Co 5 b 1-;.too r5 Medical gas(value:$ ) Page 2
Contact name: Je..a.v a r.e Primer 12.51
!� i1 Roof drain(commercial) 12.51
Address: 3 4' 1 5 ....\-A..t� t \\ .. j t V 4 Sink/basin/lavatory 25.02
City/State/ZIP: &Wirt `f Or_ . 00 5 Solar units(potable water) 62.54
Phone:(503) 61.44_ 1 3 Fax::(93)6 1-[ f - C' 13 Tub/shower/shower pan 12.51 / 2..'7
Urinal
1,e 4t V\ tO ELL N.6V S�iv\-(kOCd5. (0,AN 25.02
E-mail:
CONTRACTOR Water closet 25.02
4 Water heater 37.52
Business name:
LA.t46 1 56rJ "pt v r,\3 i N ct
Address: '6531 5W S4O. Pv'E'J-3 OtpipingfDWV 25.02
Other: 25.02
City/State/ZIP: �n L.,• tab I 0 Q„ i l 2•Iq Subtotal
Phone:(gip ) aK , ...1 0 Fax:( ,3) ay . _ j up. Minimum permit fee: $72.50
CCB lie.: , o Lic.no.:
ah,. -oZ•N P CI, Plan review (25%of permit fee)
Authorized signature: / State surcharge(12%of permit fee)
...i1 1 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name: "r,,1,,0�p,e- (.1y&EIJ Date: b'' _ i .7
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
IfBuilding\Pcrmits\PLMU-PermitApp.doc 10/01/09 440.4616T(i0/02/COM/WEB)