Permit CITY OF TIGARD PLUMBING PERMIT
• '"_ COMMUNITY DEVELOPMENT Permit#: PLM2020-00320
Date Issued: 8/17/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 25109AA02000
Jurisdiction: Tigard
Site address: 14450 SW 130TH AVE
Project: Pangares Subdivision: WOODFORD ESTATES Lot: 8
Project Description: Permit to inspect and final work performed in 2003(PLM2003-00060)for clothes washer,dishwasher and sink.
Contractor: OWNER Owner: PANGARES,CARY J&TRACEY L
14450 SW 130TH AVE
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 08/16/2020 $25.02
Specifics: 1 ea Dishwasher 08/16/2020 $25.02
1 ea Sink 08/16/2020 $25.02
Type of Use: SF 1 12%State Surcharge- 08/16/2020 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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.
Issued By: / Permittee Signature: O /tli",1°G `A �.-70" /
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 Applicatio'RECEIVE
Site Utilities hoR o1lit-f; 1 tih ONLY
City of Tigard AUG 0 3 2020 a`e""`d e is� Permit No.
w 13125 SW Hall Blvd.,Tigard,OR 9722�.�T D` Y #�t;M ZdZa "pp3 LO
tf Plan Rini
t Phone: 503.718.2439 Fax: 503.598.1501 Y OF TIGARD D ttelBy Other Permit No.:
TIGr1RD Inspection Line: 503.639.4175 BUILDING DIVISION Dale licady1By: .sass: iil See Paget for
Internet: www.tigard-orgov Notified/Method: Sepptemeata1 Information
TYPE OF WORK FEE* SCHEDULE
ID
New construction El Demolition For special information rise checklist
Description I Qty. I Ea. I Total
,21 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 tt for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
-and 2-family dwellingSlit(2)bath 437.78
❑C anmcrciaVindus[rial
0 Accessory building El Multi-family
SFR(3)bath 500.32
----- Each additional bath/kitchen 25.02
0 Master builder ❑Other:
Fire sprinkler( sq.It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
` 1-lCatchbasin.or areadrain
Job site address: � Liv'i� �� l 3(� ri iJ� 18.76
City/State/ZIP: T-1 tI lor(L , 012- QI f.. / Drywell,leach line,or trench drain 18.76
1 -y (4 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt,no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
c44)P1s. IR t W t k e_ a u.l,L M 9 o ,,s A O Rain drain connector 18.76
?1 u t-t"C- o Csi a-sE4- P.1 CC,q)LEFT Q rJ B aosA } Sanitary sewer(no,linear ft.: ) Page 2
(Z L(�11T Q (3 0 }� ..„,0 Storm sewer(no.linear fl_: ) Page 2
Water service(no.linear It: ) Page 2
Subdivision:
llaOOQc-r](ZO 1„...,e,- 5 I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Ir-, SP€c.-T '--t AC S�PE a� �sJorc.f� Clothes washer 25.02 ,t��
'€J Dishwasher I 25.02 .1-S.,0 2-
Co w-' (.€ T� S t.( t._ i f 01('1� Drinking fountain 25.02
Ejectors/sump 25.02
ROPF.RTY OWNER I 0 TENANT Expansion tank 12.51
Name: C f AZ i t ` C e1.1( P A N(t.A(L1E,S FixtureJsewer cap 25.02
Address: )Li LI St) 5� 0-l�tl- lick} _.. Floor drain Moor sink/hub 25.02
City/State/ZIP: l 4 Pit,(J Oft.- 91 Pau Garbage disposal 25.02
Hose bib 25.02
. Phone:(az) 913 - t( 6"f 9 Fax:( ) [cc maker 12.51
D APPLICANT ❑ CONTACT PERSON Iuterceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name: _ - rS ASt 0
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory t 25.02 ,0`).
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) f Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
C-ar1lJAv, oNt er- . Cot'"
! CONTRACTOR Water closet 25.02
lam''". Water heater 37.52
Business name: /t
�j,4tJ Aff CY Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal " S,i}6
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: Plumbing Lic.no.:
Nan review (25%of permit fee)
State surcharge(12%of permit fee) 47
Authorized signature: Oesic �i_ O� TOTAL PERMIT FEE m Q(
Print name: t P� l.((, ko, s Date: 5 I3 Ja�.1.V This permit application expires if a permit is not obtained within 180�days
/ alter it bas been accepted as complete.
*Fee methodology set by Tri•Comty Building Industry Service Board
I:tnutdingWetmits1PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)