Permit CITY OF TIGARD PLUMBING PERMIT
---11 COMMUNITY DEVELOPMENT Permit#: PLM2020-00429
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2020
T![ A! i� g Parcel: 2S102CA00930
Jurisdiction: Tigard
Site address: 9315 SW LAKE ST
Project: Reid Subdivision: VILLAGE GLENN Lot: 6
Project Description: Replacing approximately 100 ft of sanitary sewer on property.
Contractor: PQW CONSTRUCTION LLC Owner: REID LIVING TRUST
23300 NE ARATA RD UNIT 99 9315 SW LAKE ST
WOOD VILLAGE, OR 97060 TIGARD, OR 97223
PHONE: 503-869-8852 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 10/21/2020 $62.54
Specifics: 1 12%State Surcharge- 10/21/2020 $8.70
Plumbing
Type of Use: SF lc) ea Minimum Fee Adjustment- 10/21/2020 $9.96
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 conlained 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 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 . .1987 or 1.800.332.2344.
Issued By: Permittee Signature: n]' ,4et/c'e �
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 'T�`7z-G 1 ���tt(!ll���vVV
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.
PIumbing Permit Application _
Building Fixtures riECE-71VED
IN City of Tigard OCT 21 2020 RCe1VC /d PUl1jo�G042q
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Hate By �.�� zOZO Permit Na:
Platt Review
s • Phone: 503.718.2439nLine: Fax: 503.598.1960' OF TI GARL Date/8y: Other Permit No.:
TIGAPD Inspection Line: 503.639.4175 >Ir� nI1nC(n• pate Ready/By: inns:
Y y S See Page 2 for
Internet: www.tigard-Or.gov - - Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For specie!information use checklist
❑New construction 0 Demolition
Description [ Qty. I Ea. I Total
ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
•and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500,32
Each additional bath/kitchen 25.02
❑Master builder 0 Other. Fire sprinkler( sq.ft.) Page 2
JOB SITE,INFORMATION AND LOCATIONJ Site utilities:
Job site address: CT• f 5' S"W �'.ei k C'^-pCatch basin or area drain 18.76
! 1 i Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1 k,� 04 9 •?-2+'z,3
[ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name:gee/ace,
Soi h!4:21,y Slioje, Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: t/1n5 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.: Backflowprevcntcr 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Pei)Ira G, C3, Qra Xi tfa 1?h /( 7` )4)1 i-ti{-61,t tj Dishwasher 25.02
5eirt e ie 0r� FtYO el 4 ' Drinking fountain 25.02
//// Ejectors/sump 25.02
0 PROPERTY OWNER 1 0 TENANT Expansion tank 12.51
Name: Fixture sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: ,
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) ice maker 12.51
`❑-APPLICANT. y ONTACT PERSON Interceptor/grease trap 25.02
Business name: PO A Cf9.Ir1,5 IrV'C-1-:*14-l on I itP' Medical gas(value:$ ) Page 2
t v t!� a7I is Primer 12.51
Vi
Contact name: ceetk, tot,
Address: Z,? 0 �! ,/� �J y��•�, /} Roof drain(commercial) 12.51
(v 6,73,'(-t+t F�1) Cr.n 14- Sink/basinJlavatory 25.02
City/State/ZIP: l,°e '' ; „a� 'y4l Q 7c)6,0
VV .. U I �)Gt s Solar units(potable water) 62.54
Phone:(/7-P) '7 z -9 CI�I ' . 1 Fax::( ) Tub/shower/shower pan 12.51
E-mail:e9h/r.v .5 L�.Lf/fi�-7 C3Y'I l i f-' o �I t_1 s I..,,, Urinal 25.02
T CONTRACTOR Water closet 25.02
Business name: �1//}} /` ,,,t^ r 1,
heater 37.52
rIY i� l0e is-jn/,-T(o t t,L, ..- Water piping/DW V 56.29
Address: 4:500 A/E 4-ef-A -/k K.D U fu 4.-i q Other: 25.02
City/State/ZIP: f�1f (,/i 1 f ,X .. 9 67° Subtotal
Phone:(5' o �Gl6 9...„6.-��' Fax:( ) Minimum permit fee: $72.50
CCB Lie.:' z_U 7��? Plumbing Lie.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:�^
j TOTAL PERMIT FEE
Print name: ,/,Z0, `/ Date:/O/?p try y This permit application expire If a permit is not obtained within ISO days
'/ „ ( / t.ri�.tri'" after it has been accepted as complete.
*Fee methodology sot by Tri-County Building Industry Service Board.
I:\Building\Permns`YLMU-PermliApp.doe 10/01/09 4404616T(I0/02/COMMED)