Permit CITY OF TIGARD PLUMBING PERMIT
111 2 COMMUNITY DEVELOPMENT Permit#: PLM2020-00422
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2020
TIGARD g Parcel: 2S110DB00200
Jurisdiction: Tigard
Site address: 15199 SW ROYALTY PKWY D
Project: Arbor Heights Subdivision: WILLOW-BROOK-FARM Lot: 8
Project Description: Building ID: Replace pressure reducing valve and shut off valve.
Contractor: ANYTIME PLUMBING&DRAIN CLEANING Owner: ARBOR HEIGHTS VENTURE LLC
PO BOX 495 BY SECURITY PROPERTIES INC
LAKE OSWEGO, OR 97034 ATTN BOB KROKOWER
701 FIFTH AVE STE 5700
SEATTLE,WA 98104
PHONE: 503-894-8241 PHONE:
FAX: 971-255-1965
FEES
Quantity Description Date Amount
50 Misc Other Fee 10/19/2020 $50.04
Specifics: 22 ea Minimum Fee Adjustment- 10/19/2020 $22.46
Plumbing
Type of Use: COM 1 12%State Surcharge- 10/19/2020 $8.70
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: %14, .._— PermitteeSignature: gc 0.1 pt- c - c,
1�
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 Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
. - 13125 of Tigard Received !Q I`1/�. _,n0 Permit NcP(tM� _00 N 21,�
e 13125 SW Hall Blvd.,Tigard,OR 97223 O C T 1 4 2020 Plan Rev 1 /1 �j
Phone: 503.7182439 Fax: 503.598.1960 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 Date By
TIGARD pCITY OF TIGARD Date Readv,By: in I/9/ Ala orris: 0 See Paget for
Internet: www.tigard-or.gov RI III LING DIVISION Notified/Method: ! /p! Supplemental Information
TYPE OF WORK 6711 ttjr in tf FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
PI Addition/alterationrreplacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
r��1 SFR(3)bath 500.32
❑ 4Z4
Accessory building Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(_sq.R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13'I 1 SW 12_01 i i .tf f yr l ti Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Till D IC-. '1_7Z _ Footing drain(no.linear ft.: ) Page 2
\
Suite/bldg./apt.no.: Project name: &4/1u12_ I-' 1Yl 11s Manufactured home utilities 50.03
Cross streeddirections to job site: ��1 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
-
DESCRIPTION OF WORK Backwater valve 12.51
1 .flE 1 Nil f n, / SHIM-
6 ,W � ; Clothes washer, 25.02
l/ (j., �C,`A( �� per,, � / Dishwasher 25.02
I II �� I 1p 3r3iG2E '��dL[G(,1( L(ffs Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: IA l i S Fixture./sewer cap 25.02
FlAddress: IS I(AG\ t'lftl �01, rt ~ ek_v(i i Garbage
geaiispoorsinkl}tub 25.02
�'���[ V v t f/ I f K 'J Garbage disposal 25.02
City/State/ZIP: . 11. .f... , D 11 714- Hose bib 25.02
Phone: I
(�C� 2��-- I L+ �I Fax:( ) Ice maker 12.51
IA APPLICANT' ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: 0 N E 1 I✓121 L. eta miter I. ' eA I N/ c i s a//A/yr Medical gas(value:$ ) Page 2
Contact name: `�I( t {t L ail
1 �il� N Primer 12.51
S ""1 . i"-' 'Roof drain(commercial) 12.51
Address: co ftx 4a5 Sinkbasin/lavatory 25.02
City/State/ZIP: 1_1L -f 0 c ri(a.10 0 iZ q'1 O Solar units(potable water) 62.54
Phone:(SO.}�lcSpQ 4l��jg 74 It �y Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Atit V, ZQ�I�j-1-i al f r,�1 n bP Y.U S Urinal 25.02
Water closet 25.02
CONTRACTOR
�� y1� �,f @ ftJ e Water heater 37.52
Business name: i f ' y� � I(1!�I J Y+ ��ft 11 l j L fit(� �c ater piping DWV r p�,/� 1 rl 56.?9
Address: 190 hX L (,�.fn'' �'/ -ter Other:S - 0 i , A L 25.02
City/State/ZIP: 4 /a ('S`Y l�(„p f 61 11 D' Subtotal , 6_1-
Phone:66 ) fi i 4.- 8��'j `��I Fax:( ) 751111
_ Minimum permit fee: $72.50 t�,
Plan review (25%of permit fee)
CCB Lic.: I4I-ma} PlumbingLic.no.: eeg/l g ^0
1State surcharge(12%of permit fee) t
Authorized signature: V "" 4 /t /'\I , TOTAL PERMIT FEE +,`zO
Print name: t(`(I-i-U}i{ l` . Date: i 0'��1 This permit application expires if a permit is not obtained within 180 days
} after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
1.1Buiklina.Permits':PLMU-PcrmihApp.rluc lt1'01/O9 440-4616T(10/0I1CONFWEB)