Permit CITY OF TIGARD PLUMBING PERMIT
1111, COMMUNITY DEVELOPMENT Permit#: PLM2020-00359
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/21/2020
Parcel: 1 S125DA05900
Jurisdiction: Tigard
Site address: 6740 SW ALFRED ST
Project: Karlson Subdivision: KINGS VIEW Lot: 45
Project Description: Remodel to repipe water lines and replace bathroom fixtures.
Contractor: OWNER Owner: KARLSON, RUVIM
6125 SW 32ND AVE
PORTLAND, OR 97239
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 09/11/2020 $25.02
Specifics: 1 ea Dishwasher 09/11/2020 $25.02
2 ea Sink 09/11/2020 $50.04
Type of Use: SF 1 ea Tub/Shower/Shower Pan 09/11/2020 $12.51
Class of Work: ALT ea Water Piping/DWV 09/11/2020 $56.29
Type of Const: 1 ea Water Closet 09/11/2020 $25.02
Occupancy Grp: 1 ea Water Heater 09/11/2020 $37.52
Stories: 1 12%State Surcharge- 09/11/2020 $27.77
Plumbing
Total $259.19
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 ar- 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 50�j.1987 or 1.800.332.2344.
Issued By: iL I� Permittee Signature:laVi RIC,wi-sue.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This .ermit 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 1)0I11'it AlViiCati(RECEIVED
iUui{dmg Fixtures AUG 3 1 s FOR OFFICE USE ONI %
. ry 1 2020 �n fw ,q� !q
" City or TIni it ll ),,c• tt l/l)/� 40 Pernnr Na�Ln l,020`W?J 1
i312iS ,ihwlsad Ifare.OR 47eLITYOFTIGARD i
4,1/41
1'ilouc• sL.'!Y,. 4 1 ae: i{i? ( t, Ulhcr Permit No.:
81lIrdING DIVISION
fc. Inaucuon zinc503.639.4. :75 )xe i 1 r .,nai I �, ,oru 1171 See Page 2 fur
Iitc cruet• trwwuiard-ul'.LU' `„ ,,.,vv.. . Supplemental Information
r- .. - ... TYPE OF WORK. . 11 LI-. 14LV( !-'L FEE* SCHEDULE
= i ' For special ,.fecial in nrueurion use checklLrt
' \ in
ew construction to i r....._ �... _ ..
1 1)c.er,l,Iion 1 Qty, I Ea. I Total
r--
XAt',c'.ilioniniteraf ion/replace men t ❑Other: `..ew i..2-tannily AIII,C11111(44(Include,: 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION sl.R, lt,,I''1 I 312.70
X t-and 2-firmly titvclling r ❑Cammerci,l'lindusiria, S'`).''-,h:u:1 437.78
5PR0)hair, 500.32 ,
,J Accecorybuilding ❑Multi-lamily
1 Each additional bath/kitchen 25.02
\-taeter builder ❑Other: 1,ire eprinklcr 1.�cq.tl.) I Page 2
_ I.IOfi RITE INFORMATION AND LOCATION I '±iie ul lilies:
;oi),me dildre.g, �"" �1✓'� Ca:c k ue ,O, ,1 ca d^.un 1I 18.76
���� :l^tt4 tw, ,1e cr tremo,oajn 18.761
,,... ' e"" "" Di 00,... FVat,ns clt:uu;na rhmr ft ____; I Paget 1
`,.”'r,"-dg dtpL-rnl_: Pro eel name_ ' 41unut;lGured home utititicc I 50:03
CrI �street:direcliari to t�'1 "' Ave.--,--, rMaai#wies '
; 18.76
% 54/ Tpri(wel5 FY.
Rain arau.m=,atetur 18.76
"- 1
, Sanoary.:ewe, yio_t;near tt.. t Page 2
.-.-.�.•.•..- Sl„ille ewer Imp near it 1 Page 2
Aa e service 1,1:o .,'ear it. i ! Page 2
w:`>rr,t'i.ian: Lan no 1"islnrc or item:
1,:Ix rn,lpfParCci flit.:
Rack GtiW prevenicr 31.27
43;:ckw;c:er t five 12,51
DESCRIPTION OF WORK i
I
C..,lilt tt o C r / 25.02 Z p1„
WA LANs Iryz- IpC rt cJ ," &I Pc .,.1 a 1 !.1 1f 25.02 24402,
/r-
12- 7 rYrfZW`' ag]7 LAWN Of ( Or-'1 )i:, 1 orn_ 25.02
p t P ; I C pV,1O P ¢ - k v ►mo AO I e'._.14 aimI•.� _ 1.1 25.02
It PROPERTY OWNER ❑ TENANT lix;rnu,em Surat 12.51
1, so e_'vi A )c.A-2CSo r•1 r..t n,e ewet:a^ I 2s.a2
f� •„ ,t s u u d.,111 tuts:nub 25.02
\a'�'reti.: 10 I ZS 5 t..J 7 N'� y7'v - i ,',.,.r: 1 25.02
Ci viState/'J.!P: (70,(MAJ.D O e172- 1 i,,„:„,, I 25.02
Illtorre:(9,3) -;3 .-t itb r Fax:( ) cc Matt er I 12.51
I Y"APPLICANT 0 CONTACT PERSON atcrcep orlyre t.c imp 25.02
Medics;pt.: caluc:S ) Page2
1;a:e,c;;name: .../ .-- `
1/Y,net f 12.51
e1 name: / V" I I
t,11 euw 1 t le C: ,:rlj 12.51
1t,ther: 1tF?. sinkil n/lit.rror4 I '2, 25.02 'jj3
V71t}{ c
(r}'�C1;rtc/ZI I': 0 Sitar unirs(notable water) 62.54
I*uau:( ) °" 1 Fax::( ) 1 •I'ut>1;hfrwer/snotver pan ( 12.51 ,12,5i
C r,n i 25.02
I.1n:1i1: c ' Ac't'€ utzoA ,Cor•1 , ! 25.02 3.S.U"Z
'
CONTRACTOR -- -_.. .......
v..,e e.r,er / 37.52 37, .S�Z
k?ueinres lulnm: 1Vau1 piping1DWV ' 56.29 s7�pa2,. t
Ad.lres;: /_(1 � Other:
C.!v!State/7.11': \' -�"r Subtotal 231, �1
Phone:( ) Fax:{ Minimum permit fee: 572.50
1' r revert (25'Y0 of permit fee)
CCU Lie.: Plpm4iny Lie, no.:
S':uc surcharge(12`Yo of permit fee) 2.1.77
Aulhnrii d xii.,natore: 'TOTAL PERMIT FEE ZJ1 t.6CI
/j/' 1 This ierneit a,iudn eao ex li e;if a permit is not obtained within ISO dia{)lgrery/
I i tt n.u�N�.., �q/ DaiDate: .+ / +A:a .titer it but:nra•n utcepl<d as complete.
•Fee Inriliodology set by rra.County Building Industry Service Board.
t-'.I4i.0,!,,,,11'.=r1„,nt'Pi,tlii-I'.vn,t1 A,.!,..I..c :WO MN a.,u-ar,!ri, sy,J2=c.IM,WI:Ii1