Permit CITY OF TIGARD PLUMBING PERMIT
: COMMUNITY DEVELOPMENT Permit if: PLM2021-00001
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/4/2021
T I G A R D g Parcel: 2S102CA00238
Jurisdiction: Tigard
Site address: 13210 SW ASH DR
Project: Re-pipe Subdivision: VIEWCREST TERRACE Lot: 7
Project Description: Two bath re-pipe.Tying mostly into existing lines. 1/6/21: REPRINTED permit to include 40 ft.of water service.
Contractor: TUALATIN VALLEY PLUMBING LLC Owner: SKORIK, DANIEL& ERENA
20460 SE HIGHWAY 212 13210 SW ASH DR
DAMASCUS, OR 97089 TIGARD, OR 97223
PHONE: 503-607-7242 PHONE:
FAX:
FEES
Quantity Description Date Amount
40 If Water Service 01/07/2021 $62.54
Specifics: 1 ea Clothes Washer 01/04/2021 $25.02
1 ea Ice Maker 01/04/2021 $12.51
Type of Use: SF 1 ea Sink 01/04/2021 $25.02
Class of Work: ALT 1 12%State Surcharge- 01/07/2021 $15.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $140.10
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: 1 �1 Permittee Signature:
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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.
Building Fixtures l Si c '10 C
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Received Permit No.: PLJ'1 Z02.1 -
City of SWHallard RECEIVED Uate By: - `�
• I3125 SW Hall Blvd.,Tigard,OR Plan Review
Pholne: 503.718.2439 Fax: 503.598.1960 Date By: Other Permit No.:
Inspection Line: 503.639.4175 JAN 0 5 2021 Date Ready/By: _tom, ' Bi See Page 2 for
i it'`�1' � Internet: www.tigard-or.gov Notified/Method; ' rf 1 Supplemental luformation
TYPE OF WOR4(11Y 01- 11GAH111 FEE* SCHEDULE
❑New construction 1 t D1 iSf8N For special information use checklist
Description Qty. I Ea. Total
Addition/alteratiotvreplacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
SFR(2)bath 437.78
t 'I-and 2-family dwelling 0 Commercial/industrial
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(,sq.ft.) Page 2
JOB SITF. INFORMATION AND LOCATION Site utilities:
Y�j2ic. lit Ask 8f
Catch basin or area drain 18.76
Job site address: f
u Drywell,leach line,or trench drain 18.76
City/State/ZIP: "T`'1 qc c- r C 1 z 2 3 Footing drain(no.linear ft.:_) Page 2
�1
Suite/bldg./apt.no.: J Project name: ry 0 1 L(14.r (5 v'G.t Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
L✓ FY t L l not C./4., Rain drain connector 18.76
J Sanitary sewer(no.linear ft.:�) Page 2
Storm sewer(no.linear It: ) Page 2
Water service(no.linear ft.: ) it/t Page 2 €j z,S 1
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DEESCRIP`rION OF WORK
/- - 1 Clothes washer 25.02
A_, c! -0 i 't�rt,.'-er 5.I y/(... ._ k) 1 S 44t'i5 Dishwasher 25.02
Perm) 4- PL Al ZGJZ.\ - Ccxyp k Drinking fountain 25.02
Ejectors/sump 25.02
,�� i Expansion tank 12.51
CI PROPERTY OWNER 1 [] TENANT Fixture sewer cap 25.02
Name: L ce Y1rn, 5 Ko ,t``
Floor drain/floor sink/hub 25.02
Address: 1-3?.\C) 5,., A-, die- Garbage disposal 25.02
City/State/ZIP: ) l OerG i 0 G2_ G 1;~2 3 Hose bib 25.02
Phone:(" C3) 31 .- 6 i{t 7 Fax:(�i,- r- g"afAt Ice maker 12.51
a APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$______) Page 2
Business name: -fi">r)c.,,t( .,-{-i n V cA 1 Fe 1 �vort�Dl n�- , L f_( Primer
tt 12.5 t
Contact name: L,t;,,r r„t Vt✓T R.r 5 Roof drain(commercial) 12.51
Address: -Zr)`tLtJ SI' 14Wj Z17. Sink/basin/lavatory 25.02
r^ Solar units(potable water) 62.54
City/State/Z1P: ����5L v 5 1 02 -( �U�'j'9 (P
(5 1 607 Fax:: (3LtTub/shower/shower pan 12.51
Phone: U ) Z�(2 (�U�) S 5 5 -� ( -
4 Urinal 25.02
E-mail: L P C/2 T�/e,tc,-in Vci l 1-e.t .7 v,m b*M t i C_tarri Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: '-Fv a le,-,n Va l I e7.-.. ?1 iim br n j , Lt c Water piping/DW V 56.29
Other: 25.02
Address: '�i{� se. �1mr-l �,IZ Subtotal 6�,5t.�
City/State/ZIP: Dayyi45 0_05 O R c '7 0 c"i
! Minimum permit fee: $72.50
Phone:(`i07j) CCj"r 7Zt(Z Fax:(s��3) 5`j '��� 1
Plan review (25%of permit fee)
CCB Lic.: -zoo 1 '- OZ Plumbing Lie.no.: Z Li PB
2o State surcharge(12%ofpermit fee)
Authorized signature: �2 z_____...__., TOTAL PERMIT FEE
nit This permit appiieafion expires If a permit is not obtained within ISO days
Print name: i l C7 l n m�(/P 5 Date: "Z I aker it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building,,Pmmits\PLMU-PcrtnirApp.doa 10/01/09 440_4616T I0/02/COM/WED)