Permit CITY OF TIGARD PLUMBING PERMIT
n11 COMMUNITY DEVELOPMENT Permit#: PLM2 020-0031 9
Date Issued: 8/19/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1S126DC03300
Jurisdiction: Tigard
Site address: 9900 SW GREENBURG RD, STE#210
Project: Spec Space Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: Relocate(1)sink and (1)dishwasher.
Contractor: DP PLUMBING INC Owner: MEADOWS 196 LLC
15825 NE SPRINGBROOK 5665 MEADOWS RD STE 140
NEWBERG, OR 97132 LAKE OSWEGO, OR 97035
PHONE: 503-537-9492 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 08/14/2020 $25.02
Specifics:. 1 ea Sink 08/14/2020 $25.02
1 12%State Surcharge- 08/14/2020 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 08/14/2020 $22.46
Type of Const: Plumbing
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.
Issued By: f�/ Permittee Signature: 61,1, C--1/70 j
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 'V
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
Building Fixtures pp (�C �/ FOR OFFICE USE 0\1.1
Ci of Tigard R EC E I dl " ived P �0 /y ,�y 3 i
ty !i Davey: G/��J �'Vl Pnmit No.:�� / {�tr WJ�_l
lig13125 SW Halt Blvd.,Tigard,OR 97223 Ptah Review
• r Phone: 503.718.2439 Fax: 503.598.1960 JUL 30 2020 Date/By: Other Pennit No.:
lit 1 it I 1 Inspection Line: 503.639.4175 Date Ready/By: Jurlr. 65 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGFtR puht,d,Mcthod. Supplemental Information
TYPE OF WOIl UU DING nIVISION FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
1 CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling 10 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑ Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: a Q 00 S, t( 6-t 0 k kV le� Catch basin or area drain 18.76
t 1 V V IN v I`-`- �/ Drywell,leach line,or trench drain 18.76
City/State/ZIP: J
Footing drain(no.liurar ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 5
i
2�d �`e t. CQ Manufactured home utilities 50.03
Cross street/directions to job site: / - Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear fL: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear It.:_I Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map:parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.5I
',Ville ,f,�+- /�� Clothes washer 25.02
1 ,LV lle Sink ! W L 'V- Dishwasher I 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drainitloor sink/hub 25.02
Address:
Garbage disco sal 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: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory a 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: be P�uitr� t d' Water piping/DWV 56.29
Address: IEAzs' /F \�(�yy�mai /1 Other: 25.02
City/State/ZIP: N � XXX n/ ?13t Subtotal
Phone:(�) siq- -Nig �+ Fax:( ) Minimum permit fee: $72.50 72, 5 O
u �� Plan review (25%of permit fee)
CCB Lie.: 1211 Plumbing Lie.no.:
State surcharge(12°a of permit fee) (^t (7
Authorized signature: TOTAL PERMIT FEE Qrj) .l. S
Print name: Cl J}a r„s pt/Iffy/ Date: "7/ ,/ �1 This permit application expires if a permit Is nut obtained within 180 days
t t kl V WM �f� after It has been accepted as complete.
'Fee methodology tel by Tri-County Building Industry Service Board.
1:4tuitding\Permits\PLMU.PermitApp.doe MO 1/09 4141-4616Tt19/02COMIWCR)