Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00086
Tigard OR 97223 503.718.2439 13125 SW Hall Blvd.,Ti Date Issued: 3/2/2021
TIGARD9
Parcel: 1S125DD09200
Jurisdiction: Tigard
Site address: 9670 SW VENTURA CT
Project: Cleanline Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 100
Project Description: Bathroom remodel-replace fixtures only
Contractor: D& F PLUMBING CO Owner: WILLIAMS,THOMAS JUSTIN
4636 N ALBINA AVE 9670 SW VENTURA CT
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE: 503-282-0993 PHONE.
FAX: 503-288-0604
FEES
Quantity Description Date Amount
1 ea Lavatories 03/02/2021 $25.02
Specifics: 3 ea Tub/Shower/Shower Pan 03/02/2021 $37.53
1 12%State Surcharge- 03/02/2021 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 03/02/2021 $9.95
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: Homy—
VG1Ntr L7e/WP,gG Permittee Signature: Ovt�r�l]�]�L%Ca tf Qn
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 FOR OFFICE USE OwlX-11111111111
NIw City of Tigard Received ,1�
s 13125 SW Hall Blvd.,Tigard,OR 97223 I)nteilty 3'2, 2` t�U Permit No pLtM�7/Ys 1J>v10
f Phone: 503 7I82439 Fax: 503.598.1960 Plan Review
Patedly Other Permit No
Inspection Line: 503.639,4175 - _.-_ _TIGAR � Intcmct: wvrc.ligOrd-or,gov Dale Ready Ily 31Z'Z Nv
r rre
0 See Page 2 forNotiIicdlMhod
Supplemental Information
TYPE OF WORK "st(a Zo)'',
FEi;, SCIfEDULF.
0 New.construction ❑Demolition _ __-_.Ior yetval information ace chechdict
---- Description.ISt (
Addition/alteration replacement -
_._ I --Ta- Total
P 0Other: New 1-2-family dwellings(includes 100 Fl_ for each utility connection
CATEGORY OF CONSTRUCTION SIR(I)bath 312.70
XI-and 2-family dwellingSFR(2)bath
❑Commercial/industrial 437 7k
-- _-- 1 SFR(3)bath
❑ Accessory building Multi-family _ NXl.32
El
- - Each additional bath/kitchen 25 02
❑Master builder 0 Other: ,
Fire sprinkler(�sq.ft.) Pagc 2
JOB SITE INFORMATION AND LOCATION Site utilities:
i Job site address: 16' 1 LiemiurcA /c /'j Catch basin or area drain 18.76
City'State/7,IP: 77 ," /' f) ci ?z 2 3
Drywell.leach line,or trench drain 1 A.7b
i/�r 1` ( /�' Footing drain(no.linear ft.:_) Page 2 J
Suite:'bldg./apt.no.: Project name: C J t`aii/0 N Manufactured home utilities 50.03
1
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
-I Water service(no.linear ft.: 1 Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Back flow preventer 31.27
DESCRIPTION OF WORK Rarkwatrr valve 12.51
3 - Clothes washer 25.02
tits f t, 11'I17Oet I , Dishwasher 25.02
Drinking tbuniain 25.02
Ejectors sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: ' Fixture sewer cap 25.02
Floor drain/Ikxtt sinkhub 25.02
Address:
Garbage disposal 25.02
City/State/Z1P: Dose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON interceptor/grease trap 25.02
Business name: D(„id F P(ut/7649 Medical gas(value:S 1 Page
A, Primer 12.51
Contact name: Q c v j' t r i-n Si; Roof drain(commercial) 12.51
Address: 1 Z 00 7 Jt- A4 q 5 n' _cant:04 vc(' Sink basin/lavatory 1 25.02
City/State/ZIP: V (ixtwr 04- q86 d L Solar units(potable water) 62.54 ,
Phone:(503 -Z 9 2-0 Rg Fax::( )
Tub/shower/shower pan > 12.51
nal
d�J� b(`(iI�GV I0,10 (laAlT ei A✓a biO.j,corr Water 25.02
E-mail:ail: Water closet 25.02
FCONTRACTTOR Water heater 37.52
_Business
name: C) aiid etc")
piE,trribi�'q Water piping/DWV 56.29
5.02
Address: /Z007 ME 15 ") $/ Vtteicove' wh ig gZ Other_ total
City/State/ZIP: Vewliotnror '�f k 9eb 5 Z __ Subtotal
Minimum permit lee: $72 50
Phone:(360) 72 7-06 Fax:( )
s Plan review (25%of permit fee)
CCB Lic.: `7 6 5 Plumbing Lic.no.: L 6-2 3 P a State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE 8�.ZO
This permit application expires if a permit is not obtained within 180 days
Print name: Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Boant.
I.10ai ,permiislPLMU-Perm6App.doc 10/0t,119 440.4616T(!0'02/COMIWEB)
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