Permit (192) CITY OF TIGARD PLUMBING PERMIT
I..' COMMUNITY DEVELOPMENTIN
Permit#: PLM2018-00419
Date Issued: 09/10/2018
TR.3A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104BA15100
Jurisdiction: Tigard
Site address: 13510 SW LIDEN DR
Project: PLUEMJIT Subdivision: CASTLE HILL NO.3 Lot: 181
Project Description: Replacing(1)shower pan.
Contractor: ARTWORK CONSTRUCTION LLC Owner: PLUEMJIT, CHANISDA
8312 SE ASPEN SUMMIT DR 13510 SW LIDEN DR
PORTLAND, OR 97266 TIGARD, OR 97223
PHONE: 503-975-9851 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 09/10/2018 $12.51
Specifics: 1 12%State Surcharge- 09/10/2018 $8.70
Plumbing
Type of Use; SF 60 ea Minimum Fee Adjustment- 09/10/2018 $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 o, ai a copy...-if the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: �,"
tea..-. ac-a_
�rool.....-
Call 503.639A175 by 7:00 a.m.for the next available in = '0r-!
This permit card shall be kept in a conspicuous place on the job sit• p etion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application ;
Building Fixtures �� FOR OFFICE USE oNLv
City of Tigard Received
= a 0 '�t 1 F` Permit No.: ��`� j y al ,p
14 13125 SW Hall Blvd.,Tigard,OR 97223 ;r ate/By: /! �0 I /
Plan Review
lig I Phone: 503.718.2439 Fax: 503.598.1960 v, _., o By Other Perm
itNo.:
T I G A R n Inspection Line: 503.639.4175 , 15 ` $_ 1 .r/te-sR eady/By: Juris: la See Page 2 for
Internet:
www ttgard or.gov
- . P- CT LO GDV ldititethod: "-tey
Supplemental Information
ti: 'vE
OF WORK ' FEE*.$CHEDtILE
El New construction ❑Demolition For special information use checklist
Description Qty. Ea. Total
VAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
" .0, ATORY OF CONSTRUCTION , f. SFR(1)bath 312.70
0 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
ElAccessory building 111Multi-family
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
El Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
,.:• JOB SITE INFORMATION LOCATION .1/1 . Site utilities:
Job site address: f 5510 Stiv /i e 4., 1- Catch basin or area drain 18.76
IQ Drywell,leach line,or trench drain
City/State/ZIP:` j)7 l/
18.76
Footing drain(no.linear ft.: ) Page
Suite/bldg./apt.no.: Project name: 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
,n r Backwater valve 12.51
,. Ak .. . i DES , .•,.=i...I OF WORK �.
/� (' Clothes washer 25.02
-re/0 ieL-ei SAOiA.�'e/ p Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
41,,i' ''''' 11.� . $ . .: 0 TEN _ ,x4,2:. Expansion tank 12.51
Name: e/� lr 1 t�e I'r'1 a Fixture/sewer cap 25.02
Ci Floor drain/floor smk/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
, ' Interceptor/grease
..,� APPT.I: i ... ��. .-;'� � ONTACT 1;e1:.!�. • trap 25.02
Business name: 0.e. 04/ef,y ,j,, Medical gas(value:$ ) Page 2
�% Primer 12.51
Contact name: js^ �`; KCJrt 4 1'0a Roof drain(commercial) 12.51
Address: (4i) //Vy ��Tai
Sink/basin/lavatory 25.02
City/State/ZIP: rP�P'//( ( re Solar units(potable water) 62.54
Phone:( .)) 72 )- 09 S-9 Fax::( ) Tub/shower/shower pan 1 12.51 11-5/
E-mail: Urinal 25.02
.
. = •x Water closet 25.02
j�®.,'# t NTRACTOR RC1 Water heater 37.52
Business name: r ",Odie /„,7rfy.-;/oil Water piping/DWV 56.29
Address: // l f/_, ,s C'<' Other: 25.02
City/State/ZIP: r1 !• C q Q 9722L Subtotal 1,A 5I
Phone:( 5'L .'?) i ?-) --g 7 5 I Fax:( ) Minimum permit fee: $72.50 '7s,
CCB Lic.: f,��z /�l ie .ing Lic.no.: Plan review (25%of permit fee) -
/Clef� �/ State surcharge(12%of permit fee) g 7t)
Authorized signatl�E? �� _.------> Lr1`J-�
TOTAL PERMIT FEE 1,
�� �,/� qThis permit application expires if a permit is not obtained within 180 days
Print name: � .. - t !'r GL'��t-fy/.t, �,r Date: U7710/2vr1 after it has been accepted as complete.
L *Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
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