Permit (99) CITY OF TIGARD PLUMBING PERMIT
III "� Permit#: PLM2019-00054
s COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2019
T t C.;y is 1) 9 Parcel: 2S111AA05500
Jurisdiction: Tigard
Site address: 8849 SW GREENSWARD LN
Project: Triebold Res. Subdivision: GREENSWARD PARK NO.2 Lot: 41
Project Description: Replacing(1)dishwasher,(1)garbage disposal,(1)hose bib,(2)sinks,(1)lavatory,and(1)water closet for kitchen
and bathroom remodel.
Contractor: LIBERTY PLUMBING Owner: TRIEBOLD, ROBYN L
11124 NE HALSEY, 3534 8849 SW GREENSWARD LN
PORTLAND, OR 97220 TIGARD,OR 97224
PHONE: 503-888-8830 PHONE:
FAX: 503-912-0184
FEES
Quantity Description Date Amount
1 ea Dishwasher 02/11/2019 $25.02
Specifics: 1 ea Garbage Disposal 02/11/2019 $25.02
1 ea Hose Bib 02/11/2019 $25.02
Type of Use: SF 1 ea Lavatories 02/11/2019 $25.02
Class of Work: ALT 1 ea Water Closet 02/11/2019 $25.02
Type of Const: 2 ea Sink 02/11/2019 $50.04
Occupancy Grp: 1 12%State Surcharge- 02/11/2019 $21.02
Stories: Plumbing
Total $196.16
Required Items and Reports(Conditions) I
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. 987 or 1.800. 32.2344.
,4- ,
Issued By: /#'; 4 / 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 Application Y‘ -
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Building Fixtures ',!,,,s5.11'"" ,',n FOR OFFICE USE ONLY
v ... ... Jh3
City of Tigard 7 T Received n it- /? d P N i 7 cj
. '. 13125 SW Hall Blvd.,Tigard,OR 97223 610? `, ` 83.3 Date/By: Z.
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: P ' � /..-O (,�G
TIGARD Inspection Line: 503.639.4175 t) ate Read /B tuns El Se'e`'agc 2 for
Internet: www.tigard-or.gov 0di'2 otified/Method: SupplementalInformation
TYPE OF WORK FEE* SCHEDULE.
❑New construction ❑Demolition For special information use checklist
Description Qty. 1 Ea. Total
ddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
ATEGORY OF CONSTRUCTION SFR(1)bath 312.70
/,„, nd 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
III Accessory buildingSFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION , Site utilities:
Job site address: g' S'45i c (4 6!fin S wA/c, L v Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1 iQ(a Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: T 100 d 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
. ,... Backwater valve 12.51
DECRIPTIONof.,•,..•• � Clothes washer 25.02
(K t'F'Ca'"& le et, 1"f'° n- re cL4 7--'6)(
Dishwasher f 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PRORI~RTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal r 25.02
City/State/ZIP: Hose bib 1 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT p.,CONTACT 1?ERSfjN> . Interceptor/grease trap 25.02
2
Medical gas(value:$ ) Page
Business name: 5-4 L 424/04
Primer 12.51
Contact name: �
u f a
il .^'-.emme4cial) S t,y(CS y.- 12.51
Address: Sink/basin/lavatory t 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet ( 25.02
CONTRACTOR
-" Water heater 37.52
Business name: I. c I i i i1
LWater piping/DWV 56.29
Address: 11/A r ,...1 s/ � f CS ‘----& L/ Other: 25.02
City/State/ZIP: (
mo/ t.41��t�" /7?.�Q Subtotal
�
Minimum permit fee: $72.50
Phone:(sly3) ? 3 O Fax:( )
Plan review (25%of permit fee)
CCB Lic.: t 1 b b J 5 Plumbing Lic.no.: 3-yg3P8
r State surcharge(12%of permit fee)
Authorized signature: t /„-�y v " (2 n TOTAL PERMIT FEE
Print name:6 ' �X� v),--.1�+lb 1 t Au-2,16,0..(2,1_2_,y---
(; Da This permit application expires if a permit is not obtained within 180 days
���� 1,1e
���� L/•1 (� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8849 SW GREENSWARD LN, TIGARD, April 16, 2019 at 11 :09:41 AM
OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2019-00054
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor