Permit CITY OF TIGARD PLUMBING PERMIT
111
COMMUNITY DEVELOPMENT Permit#: PLM2021-00163
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/22/2021
TIGARD 9 Parcel: 2S104DB00400
Jurisdiction: Tigard
Site address: 13588 SW WHITEHALL LN
Project: Kanno Subdivision: AMESBURY HEIGHTS Lot: 4
Project Description: Backflow preventer replacement
Contractor: OWNER Owner: LEE-KANNO,WENDY
KANNO, TOSH
13588 SW WHITEHALL LN
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/22/2021 $31.27
Specifics: 1 12%State Surcharge- 04/22/2021 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/22/2021 $41.23
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:
}folly Van/De,Weele OwApplicc tiovt
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.
Site Utilities !t*:, 01 1 ),. i Sli t P51 N
City of Tigard RECEIVED Rtelvt*4 asi 20 2021 * .PtatILI i"<4 PLI1/442,02'fr 0016'3
1112S SW'Hail BEd_ligastl,OK 97223
: it Ptitve 80/718 2439 FOX 50/598 1960 APR 19 2021
11 ittiotty
Hos Room
titaiylit cAtter PeTriSit NO
''. kopoction'inc.' 50E634 4175
T It,'t.t..f-:1 Oat Roy/Flit bri„ le Sty row 2
i le;
lnErno- WWN4 tiggird-ur,110,
fitippkwattuttit IRiformatma
CITY OF TIGARD N'Ittf"'4."t**'4 -
TYPE OF NV0141fLuiza nto St...11E1312U
__
Ll New enuetruoron i 0 drigittitniat For ciaortad orforatitaaa use ottothat
Otiatlitttioti I Qy. I a, : Total
tZI Adddidiraltetrununireplaecineni t 0 Other Nevi 1-2-6100,tOrellhito(Metudeta 100 U.for*Kit Utility COOStistoitit
CAllatiVRY 4W C(..^...NTRIVIION St-R(1)WI 31270
i 437 til Niel 78 1 7 and 2-liatittly dititicilinti t 0 Cointriatint industrial SFR(2)
SPE(31 bath 500,32
0 Accessory building 1 13 Muitt-tintif,,
- -. ----.--— Est*twititbonal badvititime , 25.02 ,
0 Milder budder ;. 0(./thur.
Fee rptitilda/ sq.ft) page 2_ , --;
JOB SITE 1181-FOIVOATION A1/0) IFEATION Site utiliatext
4
Job site address li 35ort: 5.1..3 . ‘....)fitTS44ki.-1.- 1,t.j.. Candi Wain or area dialit 18.76 1
DriiAvell,teach line.or trench drain 18 76
Cit taw I1ANLPC20?-, 91 2.2.''
/rooting drain tno bnr it: t Page 2
Suite:MAK -apt net.: i Pr *0 namc RE.P I- . eytte-1-174-01.4.) Manuticittroti home uttititevt 50 03
CrOv,'IartV1411:43,041$ttlid2 site: Niantioles. 18.76
i-tris4.1m...1- 1...P4 -4- 50 I,& -tifs+. . Emu drain connector 18.76
Saaitary sow Ow.hnett It.. 1 Pig 2 - ..
Sturm scratr(no.ttmer ft.:____, Pap 2
Watuf scrvice tn t.linttar ft' )_ Pap:.2 i
Subdt vision- Lot nu.: Fixture 4/r Item
fax Ellttp pairM no-. liacOlow preventte i 31 27 31,S1
Eardieutd valve /2.51
DEECIFJFTION OF WORK
P
- Clintri,...media 25 02 5t:ft-i-- ePle..-ft,L7 -) f P..r-k.I et--11-012-
11) 1rAtts,hct 25.02
Orng fountain 25_02
Fa4aVitliStIfIlp 25-02
1 ' X „....._ - ,piton:PTV 0 .NFIWR 0 TENANT E8P8118/00 RIF 12.51
. .. ,
Fixtiatei'8uttna-nap 25 02
_fluty drake liner sittildinfi 25 02
Addrieks.: $465-wki , fii‘,C, -Stnicid. ..„5,rre,.....
"sett disponi/ 25,02
C Iry Staleilir _
-
How bib 25.02
Phone7( i Fox:f ) Ire inaktai 12.51
c APPLaiwmr CI otprrAt:r FfttSON Intotoopteglretoe Imp. 23,02....
1111tateSS attile- St1/41,4,4, .. .k..,& pi2.04:eaLlitt otr,24,1s...)„ 4,_ $$$", 1 gft, 1v4tw-$ 3i Page 2
. i.
Primer 12.51(ranact name.
. Emir drain tootranocittf} 12 51
Addres,s
Sink basinilwatier/ 25.02
Env Stme/11'
80hsr umta(peaahk 55afer) 62,54
<
Phone r ) 1.• Fr- *( ) Tula,shout-es/tower pun 12.51
' Urinal .
25.02
E-mail. Ice(tir-IQ gar\oo. coy.c. •“INTRAcTott _
_ Wader heater 37.52
Rumness name i....,f,csike, #5535 .020 cregri" c ..)eig. i
Water piping DUN' 56.29
Addreas
(taw: 23.02
Colv'Stat 1.1P- 5Athitaital i
.
Phone r• 1 li ex:( )
1 .. . Mtnettitnn permit fee S72.50
Plan review(258a of permit'fee)
. .
CC B t Ac." Plumbing Lic.no.
! r-
-- State surcharge 0 26*of permit fee)
Authotzof tittottbitc -S...- Jr. fl jOIAL.rmtrr FEE e4,SO.
Print name -70.5 or .<441,x) i Datei ilif itee2„,i n1/51/5/180*Slitios vttltro If*permit is not ettttertnett totint t Mt 41:05
i ' alto it has bets sitosittif as C.2RVIeW
'2,4^c usithitiolimio to by 2r-I COurely Bold nititart Sento Nord
1 attg,201C2ettlita‘PL22:PdtratApp doe I CA),1•Pi 440-trittaT trolcorettioni
Page 2 - Suppleniental Information
Fee Schedule: Residential Fire Suppression Systems
_ . .
Site Utilities Qty. 1 le/eclat) total uare Foots e: Permit Fee:
kiminir,drain-17 wo 50.03 ti 61 2.410 5121 00
2tai I ki 3,600 S169.66 Finning sham-.Aelt additioinid 100' 17 52
3,601 to 7.200 $2.33.20
Sev.tv- IA 100 62 54
7201 and greater ( 532734
...51S-Ass--nett aidamnal 100° 3752
I 0 I .
st.az...-r Service- tXr 62.54 ,
Medical Gas Systems:
Water Scrocc-cacti additional IOW 37 i2
Valuation: Permit Fee:
will,.t.Nam Draw- la ItXr 62.34 ,
-,..
_ Stro s.,ssnoo On st minium tlat S
Storni st Rain I train-each additional IOW 37 52 $6001 110 to 510,03(1,0t1 $7236 fax the find 55,1100 nO Mad 51-52fttr
. -
each additional SI0060 sr tractile'thermic,.To
Other Inspections or.Fees <*- I'm") ' Tata' , and including 511.1.00It 00,
Insp.:slicer of exi fling plumbing is tot 510,06100 to SZ5,000.00 Si 441,50 tor the first 510,00000 and SI.54 for
Ishtch no fro is spocilicalls indicalial 'Al IX)hr each additional S100.00 ra fraction thiseof„lo
f minimum chart:: I'2 hour/
'. and including 52.5,000 CX)Int port6IFIS 4Itlilidc of Flurmal huNiriCks 90,00 tu S25,001 00 To$50.000.00 5,179.50 Int the first S25.00000 and 51,45 for
hours(mintneuti diaree 2 luvirs).
welt ackliticnal$100,00 or fractitin tterevd.to
Itar.spocti in 166.6 90.(10hr ' and including 5 50,0to nu
\Jitilissnal pLan rel1es,.tor rcsitisos 90 Ltrihr 53t),00 I 00 and up 5742 On fir the lira 550,000.00 and Silo for
inniumuni charge I 2 tusui ,
etch additional Sint,On or haction fivcreel
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If"yes-,
( -r
please indicate work performed by fixture. Failure to
aeon raids report fixtures could result in increased sewer fees".
- Q411111iity by nature Type Plan Review fur Plumbing Installations
linstre Type Far Steritiavi
!ion Ter lot fi Ts-quires!to: uns or the totiossi ng
Work Perfarrnetl: sappia askant liras mar
Plomse check all that apply.
I tapii'fry font • '.1111),Ru nser , 0 .4.ny new comma-cal building with untia sisvice 2-and
Bath - ' ,
-Jacut./i 11/41i irlpia 4 .
, greater,except systsans designed and stamped by licensed
'Oa'a ath -Each Stall , engtnixt
-Drir e Ihni . 0 New exterior pluntbiiigt site utilities for rely complex structure
.. ,
Cuspid,* WateT Aspirator US -.defined in()AR918-780-0-740,
Di.sliwasher -Comintern!! 0 Medical giro and vacuum systems for health care facilities.
_
-tastiest ic 0 Any multipurpose fire sprinkler systan.
Drinking l'oontain 0 An complex structure as defined in OAR918-780-0040.
Ere Wash
rIsmom III eCos Ailik -2' i Submit 1 tett of plan*with any or riw above.
Isometric or Riser Ilissararn
Car Wash Drain , ,
- El tsom&uic or riser diagroni is required for nett buildings
iisrhuge -flomiztic.-non-flasil
Thrpor dic-food related that meet the qualifications above,
•Cosomereial-fiasi refs Tail
-Industrial-ford relatod
Ice Ntach. Rarive Drains
CAI Srparaux TO-as Station) Comments regarding fixture work:
Rcc..Vehicle Dump Statical
SNllircr Mn-V _g
-Stall
Sink.tar -54.11-1aisi ottlated
-13radies
-Couutiocial-ro,x1 related
. ,
Soinnoing Pool Fitter
*Note: If the fixture work under this permit results in an
Washer-CI,ithsa
V.'ater 1....x1ractor increase of sewer EDUs,a sewer permit will be issued and
Widar Clorat-Toilet fees assessed for the sewer Increase must be paid before the
t'Oral ' plumbing permit can be issued.
osier iires.. .
I,\BuildingTerrnitied,L1stlf_1-'entniAm do, 1
..