Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00142
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/7/2021
Parcel: 2S 111 CB05000
Jurisdiction: Tigard
Site address: 10250 SW LADY MARION DR
Project: Johnson Subdivision: MARION ESTATES Lot: 23
Project Description: Back flow
Contractor: OWNER Owner: JOHNSON, MARJORIE E
10250 SW LADY MARION DR
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/07/2021 $31.27
Specifics: 1 12%State Surcharge- 04/07/2021 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/07/2021 $41.23
Class of Work: ALT Plumbing
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: Tina Escalera Permittee Signature: On application
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 RECEIVE I i tllt I If 111 1 I t f11 t 1 } ,
L City of Tigard env„y
13125 SW Halt Blvd,Tigard,OR 97223 DeteiBy: Permit No.:
■ Phone: 503.718.2439 Fax: 503.598.1960 APR 2021 Plan Review
In ection Line: 503.639.4I75 Date/By:Res other Permit No.:
" """' Internet: wwwtigard-orgov CITY OF TIGARD hiotifed/n�ld: ram; See Page 2for
Supplemental Information
TYPE Ott WORK BUILDING DIVISION FEE* SCHEDULE
❑New construction 0 Demolition Forsp
ecial information arse checklist
511 Description I Qty. I Ea. I Total j
Addition/alteration/replacement Other:
New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath _ 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
JOB SIT. INFORMATION AND LOCATION Site Fire upnntilles:ties:kler( sq.ft.) Page 2
Job site address: O�s� 5•ci, N -� Catch basin or area drain
/✓ l(/ 1 ) 18.76
Drywall,leach line,or trench drain 18.76
City/State/z1P: V 7 41 a 4
Suite/bld ./a t,no.: Footing drain(no.linear ft.: ) Page 2
S P Project name: G!/9�O.iii-4,1,7 W
N Manufactured borne utilities 50.03
Cross street/directions to job site:
Manholes 18.76
'Jc i-+/-e d1 s /0 v 7 h , 5 6J /C9 3 4 CPC., Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision_ �J9 t�rCl d� e r�f 7L� f Lot no.: Fixture or item:Water service(no.linear ft.: ) r Page 2
H
Tax map/parcel no.: Backflow preventer
31.27
DESCRIPTION OF WORK Backwater valve 12.51
r v,Nsr u c y' S Pre/Ai/rear- Sysr ,tA, earkir2a D 25.02
43
OA' " A C /� b.)1G d Dishwashers 25.02-I" Q
Drinlong fountain 25,02
Ejectors/slap 25.02
Itr PROPERTY OWNER + 0 TENANT Expansion tank 12.51
Name: A�U /`r Fixture/sewer
2 J.i NA.'.S ) cap 25.02
Address: if...)2--,.S U M Floor drain/floor sink/hub 25.02
City/State/ZIP:. 9:1 2..2-
'Sy ` , r O�tJ j Garbage disposal 25.02
c� Hose bib 25.02
Phone:(.Sd.3) 3 U d - 6.3 8cc7 I Fax:( ) /VA
Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Address: Roof drain(commercial) 12.51
City/State/ZIP:
Sink/basin/lavatory 25.02
Solar units(potable water) 62.54
Phone:( ) f Fax::( ) Tub/shower/shower pan 12.51
Y mail: Urinal 25.02
CONTRACTOR Water closet 25.02
liminess name: Water heater 37.52
lddrss:
_ , Waterpiping/DWV 56.29
Other: 25.02
'ity/State/ZIP: F F' '
'al' Subtotal
hone:( ) \Fax:( ) Minimum permit fee: $72.50 7?.5 J
CB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
uthorized signature: �yy� `y J p lr-- State surcharge T L E permit fee)E
int Warne: /j rl t r*/ TOTAL PERMIT FEE �+ (f
M'12JQ2/C- ✓c/t/N.s o N 1 Date: y-st -9,i I This permit application expires if a permit Is not obtained within
do s
after it bat been accepted as complete.
`Ere methodology set by'Tri-County Building Industry Service Board.
ruiildirePamtleWLMU-PtmitApp.doc loam I.009
440-46161'(I0/02lppMprpB)