Permit at CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00187
Date Issued: 8/27/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S111CA03800
Jurisdiction: Tigard
Site address: 9725 SW LAKESIDE DR
Project: Allen Subdivision: SUMMERFIELD NO.12 Lot: 658
Project Description: Replacing(1)shower.
Contractor: TITAN PLUMBING COMPANY Owner: ALLEN, CLAIRE N
PO BOX 581 9725 LAKESIDE DR
NEWBERG, OR 97132 TIGARD, OR 97224
PHONE: 503-421-9167 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 06/24/2020 $12.51
Specifics: 1 12%State Surcharge- 06/24/2020 $8.70
Plumbing
60 ea Minimum Fee Adjustment- 06/24/2020 $59.99
Type of Use: SF 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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: . \ /_�c ( Permittee Signature: CJ/ 7-76
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. T 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.
1 nnaan1Vaa&G a Ya L111Y sa1N Mnfl t YLVIa
Building Fixtures ri)iz i iV1 Rt F l `,1 I
��re City of Tigard nateB ' o /'� 74(t IA4. ))- Cr)/Y2
® 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rev ew OtherPermit No.:
_ ' Phone: 503.718.2439 Fax: 503.598.1960 1`PR 2 9 2020 DateBy:
T t G:R t) Inspection Line: 503.639.4175 . Date Ready/By: runs: H See Page 2 for
�y Internet: www.tigard-or.gov - Not i. r l Method: Supplemental Information
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qn: k 'j ...MI '4.:' J'IF .ae6n p y` :� ` e -..15+^� ... u'4«.ei' "SR,..Cv %. Y'."x . 1: ., r Y',.,-
For .
0 New construction ❑Demolition special information use c4ecldist.
Description I Qty. I Ea. I Total
izt Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
312.70
i1''u n 3. rn .` .:.w .wu 4. 14. . . '10.1 :a SFR(1)bath
Ci 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
£ 'AIWA�� W I - n 't V l a t'z� it m..
i+tr. &'1•
yd <�" m a t Site uh7llies:
;� .�.�.s. � sus 5r4R`f C` , ma,>prva, £.2 R.,. ...2?.x,l'. °s�'Y .
Job site address:G 125 JIA-, La KQ,sId•/e, Dr. Catch basin or area drain 18.76
n q -� Drywell,leach line,or trench drain 18.76
City/State/ZIP: 'r,(aa 01„ _I -.2.
\j 4 L ry Footing drain linear ft.: ) Page5 . 2
Suite/bldg./apt.no.: I Project name: rt/� 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
„' "✓ e� cz, f s'r e"fit t� e°", >nn ,z-, .=" i a::.,r ` `�'O" f Backwater valve 12.51
)i,A h!ar'S` srl,, Pl]. ,r .sv". ...�, 11,0,,s�k ua{� d � .. � ; Clothes washer 25.02
Ye_ VA( 4 , (I-) `mil / IL Dishwasher 25.02
t Drinking fountain 25.02
Ejectors/sump 25.02
Virg$ � M �� t;lrl 1: � ht-# r � a�,, tt4y�{�� s y e.� • ' K Expansion tank 12.51
.. ✓ u /n< '.rOXrlY
Name: 1Q 1 Yy 1T'lSt� Fixture/sewer cap 25.02
C Floor drain/floor sink/hub 25.02
Address: 1'2.5 ; i lk C.Qcl L ��r, Garbage disposal 25.02
City/State/ZIP.fl JJC l ('�l OR -1 22y Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
r ,�, xi ,r '- �r w�=`: , „.'.' ^ Interceptor/grease trap 25.02
5 .l•.c?, s .'4+ e..i sa i, .,.. _'. ot._., 9. ..ter ..>. v°r
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 1 12.51
E-mail: Urinal 25.02
�V r h 41 4.•�` Water closet 25.02
C, r- £t ,, v. A*11:ax;,s NHfx P -:;-y 'd;'/ a ,„y,.-piwi.m
<,; `:. .: 1'Z..: . . 'll .s . +,,liO'4 W-� / 7. z wr. ., <,,-;. s,", x ;.,', Water heater 37.52
Business nameTi-'an ?(Lkmbl r tvl l 1.) WC, Water piping/DWV 5629
Address: , 1111V al • Other: 25.02
City/State/ZIP: A)ell),A 1 (' tj 32 Subtotal
Phone:
q-Li I - cm/l oi • Fax:( ) Minimum permit fee: $72.50 -
CCB Lie.: 2' (.P 5 Plumbing Lic.no.: ' 6'ci�} Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized siiggnatu .f , ^ I TOTAL PERMIT FEE
Print name: r 111 A \ trim A Date: y . z C - 7 f This permit application expires if a permit is not obtained within 180 days
I•- �� is 'lam '41`-1YV1`'` after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.