Permit CITY OF TIGARD PLUMBING PERMIT
II '
COMMUNITY DEVELOPMENT Permit#: PLM2021-00082
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/1/2021
TIGARD g Parcel: 1S135DA04600
Jurisdiction: Tigard
Site address: 11163 SW HALL BLVD
Project: Village at Washington Square-Community Building Subdivision: 1998-038 PARTITION PLAT Lot: 1-2
Project Description: replace(1)water heater.
Contractor: CALIBER PLUMBING & MECHANICAL INC Owner: VILLAGE AT WASHINGTON SQUARE
2615 NW ST HELENS RD LIMITED PARTNERSHIP
PORTLAND, OR 97210 BY CPAH
PO BOX 23206
TIGARD, OR 97281
PHONE: 971-563-1672 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 03/01/2021 $37.52
Specifics: 1 12%State Surcharge- 03/01/2021 $8.70
Plumbing
Type of Use: MF 35 ea Minimum Fee Adjustment- 03/01/2021 $34.98
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: Permittee Signature:
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 iL zz ze -
Building Fixtures RECEIVED
City of tl Permit No.:Ti and Received
g C 2 0 2 Bate/By:Ii �2-� •�i� 4/ OD1_ L
1111 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Revie� -
II Phone: 503.718.2439 Fax: 503.598.19 other Permit No.:
Inspection Line: 503.639.4175lY OF TIGARD Date/By:
r1c;ARt) BUILDING DIVISION DateReady/By: furls: la See Page2for
Internet: www.tigard-or.gov Nolificd/Metttod:Z�Z/Z/ ��
TYPE OF WORK FEE* SCHP,:DULE Sup
plemental Information
0 New construction ❑Demolition For special information use checklist.
Description 1 Qty. 1 Ea, ( Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
OTEGOI,tYO?' CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building KMulti-family Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
:// './ ;3 JOB SITE..ThPFOI;A'MATION.AND LOC4.TIQN Site utilities:
Job site address: S�{ sW fact i, f1„, Catch basin of area drain 18.76
Ll Drywell,leach line,or trench drain 18.76
City/State/ZIP:
�iJcs/'el♦ OR I 5Z + Footing drain(no.linear$.: ) Page 2
Suite/bldg./apt.no.: Project name: Jat{t � Manufactured home utilities 50.03
Cross street/directions to job site: (7,0 17M ll,,i 77 4 .,Lam,,,e... 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: J Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
>,)ESCRIPTIOls' Op WORK ....'. a
-�+ + Clothes washer 25.02
-f n S /if - GusC heeds Dishwasher 25,02
Drinking fountain 25.02
' Ejectors/sump 25.02
'PROPERTY:OWNER :. '0 'ENANT Expansion tat 12.51
tk
Name: P f1__ j- , Ac1J6� Fixture/sewer cap 25.02
} 17 R ' � ,9 Floor drain/floor sink/hub 25.02
Address: ( h
3&V SW Ca}('t 1 t�4Y Garbage disposal 25.02
City/State/ZIP: prat+l,nor, o 9 �
7,a 9 J Hose bib 25.02 �
Phone:(�'V ) 3 y03 Fax:( ) Ice maker 12.51
0 APPLICANT " tj CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: C41i er Pktt-nh _ 1 met IIan I C 5 I . 1r1(.
Contact name: /° �r Primer 12.51
Tn-thtA.�, G-r-�pu5 D Roof drain(commercial) 12.51
Address: a 6 i j` N &) h f I-if Ims a Sink/basin/lavatory 25.02
City/State/ZIP: Port Icrl d 0 v R ai 11) Jo Solar units(potable water) 62.54
Phone:(503 ) 20 6 7 5 1 Fax::( ) - Tub/shower/showerpan 12.51
1 Urinal 25.02
E-mail: J t7S 17 9 €) ra Orr N7r c home,.i, f^ca7',
Water closet 25,02
CONTRACTOR. t�t3
{ ` - Water heater / ` 37.52
Business name: /' -_ill bee PIttl'1'ID1Qy 1 a C.Gill ✓ t� i �-(/!C. Water piping/DWV 56.29
Address: r'•} 6 lc- AAA.1 s+IhT 4.4e lr'1S Jj Other: 25.02
City/State/ZIP: P0 d-1 id , 0IR et...a io Subtotal 1/-4-3;tF
(�� ) • ( ) Minimum permit fee: $72.50 42 j'0
Phone: aD6. •�1 J Fax:
Plan review (25%of permit fee) f''1 7e,
r
CC13 Lie.: 08 Q t i S- Plumbing Lic.no.:Pe/6S8
State surcharge(12%of permit fee)/ .
i+,-51--
Authorized signature:''% TOTAL PERMIT FEE
n
Print name: ^�T�'-5l► + Gllf D Date;1 ,/s la0-1 This permit application expires if a permit is not obtained with
�1u 180 nys
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Mushy Service Board
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